Key result
Remote endarterectomy is linked to slightly lower 10-year primary patency than vein bypass but fewer reinterventions.
Why the study?
The study addresses issues of steno-occlusive lesions of the femoral-popliteal segment and compares methods of surgical treatment.
Does remote endarterectomy improve long-term patency and limb preservation compared to vein or PTFE bypass in patients with extended occlusion of the superficial femoral artery?
Cohort (n=141)
Does remote endarterectomy improve long-term patency and limb preservation compared to vein or PTFE bypass in patients with extended occlusion of the superficial femoral artery?
Absolute Event Rate: 22.2% vs 26.3%
p-value: p=0.006
Remote endarterectomy offers comparable long-term limb preservation and superior freedom from reintervention compared to bypass surgery for extended superficial femoral artery occlusions.
Remote endarterectomy may reduce reinterventions in extended SFA occlusion; observational data leave open its role versus bypass pending randomized trials.
Rationale: The research topic reflects the issues of steno-occlusive lesion of the femoral-popliteal segment and methods of surgical treatment.Methods: The results of open operations on the femoral-popliteal segment in 141 patients were analyzed. Three study groups were formed: №1 (n = 53) – after remote endarterectomy (RE), №2 (n = 47) – after vein bypass (VBP), № 3 (n = 41) – after polytetrafluorethylene bypass (PTFE). The period of retrospective analysis corresponded to 3, 5 and 10 years of follow-up.Results: After 3 years, the PP in RE and VBP was 78.4% and 80%, respectively, significantly lower in PTFE – 60,5% (p = 0,085). SP was 86,3%, 88,9%, and 76,3%, respectively. Freedom from reintervation is higher in RE – 54,5%, in bypass surgery groups 33,3% and 30,8%, respectively. The percentage of limb preservation was 94,1% vs 95,5% in the RE and VBP groups, 81,6% in PTFE (p = 0,02). The overall survival rate was 96,2%, 95,7% and 92,7%, respectively. After 5 years, the PP is 43,8% vs 46,3% vs 30,5%. SP is higher in the VBP group – 70,7%, compared with PTFE and RE – 58,3% and 66,6%, respectively. Freedom from reinterpretation is 44,4% vs 27,2% vs 28%, respectively. Limb preservation rates remained high in the RE and VBP groups – 87,5% vs 85%, in the PTFE group – 72,22% (p = 0,075). The survival rate was 90,56%, 87,23% and 87,8%, respectively. By the age of 10, there were no primary passable synthetic shunts. The PP of RE and VBP decreased to 22,2% and 26,3%, respectively (p = 0,006). SP is 53,3% vs 57,9% vs 41,2%, respectively. The frequency of limb preservation is 82,2% vs 76,3% vs 61,8%, respectively (p = 0,058). RE has the highest freedom from reintervation (p = 0,091). The survival rate was 84,9%, 80,8% and 82,9%, respectively.Conclusion: The advantages of the remote endarterectomy have been revealed in comparison with bypass surgery, slightly inferior to vein bypass in primary patency, which confirms the importance of the method in arterial surgery and opens up new opportunities for reintervations.
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Zhdanovich et al. (2025) conducted a cohort in Steno-occlusive lesion of the femoral-popliteal segment (n=141). Remote endarterectomy vs. Vein bypass and polytetrafluorethylene bypass was evaluated on Primary patency at 10 years (p=0.006). Remote endarterectomy was slightly inferior to vein bypass in 10-year primary patency (22.2% vs 26.3%, p=0.006) but demonstrated advantages in freedom from reintervention.
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