Revascularization Strategies for Patients With Femoropopliteal Peripheral Artery Disease

Serdar Farhan, Florian K. Enzmann, Patrick Bjorkman, Haroon Kamran, Zhongjie Zhang, Samantha Sartori, Birgit Vogel, Arthur Tarricone, Klaus Linni, Maarit Venermo, Daphne van der Veen, Herve Moussalli, Roxana Mehran, Michel M.P.J. Reijnen, Marc Bosiers, Prakash Krishnan

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: No adequately powered studies exist to compare major clinical outcomes after endovascular therapy (EVT) with stent implantation vs bypass surgery (BSx) for symptomatic femoropopliteal peripheral artery disease. Objectives: This study sought to perform a pooled analysis of individual patient data from all randomized controlled trials comparing EVT vs BSx. Methods: Principal investigators of 5 of 6 available randomized controlled trials agreed to pool individual patient data. The primary endpoint was major adverse limb events, a composite of all-cause death, major amputation, or target limb reintervention. Secondary endpoints included amputation-free survival, individual major adverse limb event components, and primary patency. Early complications were bleeding, infection, or all-cause death within 30 days. Results: A total of 639 patients were analyzed with a mean age of 68.1 ± 9.1 years and 29.0% women. Baseline characteristics were comparable between groups. At 2 years, there were no significant differences between patients who received EVT and those who received BSx regarding major adverse limb events (40.1% vs 36.4%; log-rank P = 0.447; adjusted HR [aHR]: 1.04; 95% CI: 0.80-1.36), amputation-free survival (88.1% vs 90.0%; log-rank P = 0.455; aHR for death or amputation: 1.04; 95% CI: 0.63-1.71) and the other secondary endpoints except for primary patency, which was lower in patients who received EVT vs those who received BSx (51.2% vs 61.3%; log-rank P = 0.024; aHR for loss of primary patency: 1.31; 95% CI: 1.02-1.69). EVT was associated with significantly lower rates of early complications (6.8% vs 22.6%; P < 0.001) and shorter hospital stay (3.1 ± 4.2 days vs 7.4 ± 4.9 days; P < 0.001). Conclusions: These findings further support the efficacy and safety of EVT as an alternative to BSx in patients with symptomatic femoropopliteal peripheral artery disease.

Original languageEnglish
Pages (from-to)358-370
Number of pages13
JournalJournal of the American College of Cardiology
Issue number4
StatePublished - 31 Jan 2023


  • bypass surgery
  • endovascular therapy
  • infrainguinal arteries
  • peripheral artery disease
  • stent


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