Endovascular Therapy Shows Promising Results for Peripheral Artery Disease

A new study finds that endovascular therapy with stent implantation has similar outcomes and lower complication rates compared to vascular bypass surgery for femoropopliteal peripheral artery disease. The study, which included 639 patients, found no significant difference in major adverse limb events and amputation-free survival between the two treatments.

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Aqsa Younas Rana
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Endovascular Therapy Shows Promising Results for Peripheral Artery Disease

Endovascular Therapy Shows Promising Results for Peripheral Artery Disease

A new study presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions in 2024 finds that endovascular therapy with stent implantation yields similar outcomes and lower complication rates compared to vascular bypass surgery for femoropopliteal peripheral artery disease (PAD) in both men and women. The pooled analysis of the REVIVE study, which included 639 patients (185 women and 454 men), provides robust evidence supporting the efficacy and safety of endovascular therapy as an alternative to bypass surgery regardless of sex.

Why this matters: This study's findings have significant implications for the treatment of peripheral artery disease, a condition affecting millions of people worldwide. The results could lead to a shift in treatment approaches, improving patient outcomes and reducing healthcare costs.

The REVIVE study, an individual-patient-data analysis incorporating five separate clinical trials, found no significant difference in major adverse limb events, amputation-free survival, and secondary endpoints between the two treatment approaches. Endovascular therapy was associated with lower early complication rates and shorter hospital stays compared to bypass surgery. The 2-year rates of major adverse limb events and composite secondary outcomes were similar in both treatment groups for men and women.

"Women are underrepresented in PAD revascularization trials, and so far, no robust data exists on sex-specific outcomes related to revascularization strategy," said lead author Serdar Farhan, MD. "In patients with symptomatic PAD involving the femoropopliteal segment, EVT with stent implantation vs. bypass surgery was associated with similar rates of 2-year major adverse limb event and amputation-free survival, lower rates of early complications and shorter length of hospitalization regardless of sex."

The sex-specific subanalysis revealed some differences between men and women. Technical failure was more common among men undergoing endovascular therapy compared to bypass surgery, but not among women. Concomitant common femoral artery treatment was more frequent in the bypass group compared to endovascular therapy for men, but not for women. However, the study found no sex differences in major adverse limb events, amputation-free survival, or individual endpoints such as all-cause death, major amputation, reintervention of the target limb, and loss of primary patency.

"This pooled analysis of individual patient data further supports the efficacy and safety of endovascular therapy with stent implantation as an alternative to bypass surgery in women and men," said Dr. Farhan. S. Elissa Altin, MD, who was not involved in the study, commented, "This is a really interesting and important identification that the sex differences really aren't there, [because] I think we think sometimes they might be."

The researchers note that the next step is to model cost differences between endovascular therapy and bypass surgery. They also emphasize the need for more introspection on the role of medical therapy and its potential to improve event rates, based on the consistent challenges shown in PAD treatment analyses. These findings provide valuable insights to guide treatment decisions for patients with femoropopliteal PAD, offering endovascular therapy as a viable option with benefits of lower complications and shorter hospital stays compared to traditional bypass surgery in both men and women.