Comparison of the endovascular therapy with drug-coated balloon and bypass surgery for Trans-Atlantic Inter-Society Consensus II C and D femoropopliteal lesions

Aim: The optimal revascularization strategy with the greatest durability and the lowest morbidity in femoropopliteal artery occlusions still remains debated. This study aimed to compare 2-year follow up after endovascular therapy (EVT) and femoropopliteal bypass in subjects with TASC II C and D femoropopliteal artery occlusions. Material and Methods: This study included 92 patients with extensive (TASC II C and D) de novo femoropopliteal occlusion who underwent EVT or femoropop- liteal bypass surgery. Drug coated balloons competent with target vessel diameter were used for PTA interventions. Results: A total of 92 subjects with 92 limbs treated were included in the study. Fifty-one of the study subjects received EVT and 41 underwent femoropopliteal bypass surgery. The primary patency rate was higher in the femoropopliteal bypass group compared to the PTA group at 6th, 12th, and 24th-month follow-up studies. Discusion: We compared the early and mid-term clinical outcomes of EVT and femoropopliteal bypass for TASC II C and D lesions of the femoropopliteal artery. We hypothesized that, given the superiority of drug-coated balloons compared to uncoated balloons in terms of postoperative outcomes, EVT with drug-coated balloons would provide superior primary patency compared to femoropopliteal bypass in subjects with complex femoropopliteal artery disease. However, our findings failed to demonstrate the superiority of EVT with drug-coated balloons over femoropopliteal bypass. This result supports the evidence derived from previous studies comparing the two treatment strategies for TASC II C and D lesions of the femoropopliteal artery. Our results indicate that postoperative ABI is also higher in subjects undergoing femoropopliteal bypass than those receiving EVT. Femoropopliteal bypass surgery provides a higher primary patency rate and a more significant improvement in ABI in subjects with TASC II C and D femoropopliteal artery occlusions with similar complication rates for the two treatment strategies.