Long-term results of a multicenter randomized study on direct versus crossover bypass for unilateral iliac artery occlusive disease Jean-Baptiste Ricco,

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Presentation transcript:

Long-term results of a multicenter randomized study on direct versus crossover bypass for unilateral iliac artery occlusive disease Jean-Baptiste Ricco, MD, PhD, Hervé Probst, MD, PhD Journal of Vascular Surgery Volume 47, Issue 1, Pages 45-54.e1 (January 2008) DOI: 10.1016/j.jvs.2007.08.050 Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 1 Study flowchart. Two patients declined and one patient was withdrawn after a severe stroke that occurred 3 days after randomization and prior to surgery. Journal of Vascular Surgery 2008 47, 45-54.e1DOI: (10.1016/j.jvs.2007.08.050) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 2 Primary patency of 69 direct (D) and 74 crossover (C) bypass procedures analyzed according to the Kaplan-Meier method. The number of patients at risk in each group at various intervals is indicated at the bottom of the figure. Results are expressed as percentage with 95% confidence interval (95% CI). Primary patency rates at 5 and 10 years were 71.8 ± 10% and 55.6 ± 12%, respectively in the crossover bypass group compared with 92.7 ± 6% and 82.9 ± 13%, respectively in the direct bypass group (P = .001, hazard ratio: 4.1 with 95% CI: 1.8 to 6.7). Journal of Vascular Surgery 2008 47, 45-54.e1DOI: (10.1016/j.jvs.2007.08.050) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 3 Assisted primary patency of the 69 direct and 74 crossover procedures analyzed according to the Kaplan-Meier method. The number of patients at risk in each group at various intervals is indicated at the bottom of the figure. Results are expressed as percentage with 95% confidence interval (95% CI). Assisted primary patency rates at 5 and 10 years were 84.3% and 74.8%, respectively in the crossover bypass group and 92.7% vs 86.1%, respectively in the direct bypass group (P = .04, hazard ratio: 2.5 with 95% CI: 1.1 to 5.8). Journal of Vascular Surgery 2008 47, 45-54.e1DOI: (10.1016/j.jvs.2007.08.050) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 4 Secondary patency of the 69 direct and 74 crossover procedures analyzed according to the Kaplan-Meier method. The number of patients at risk in each group at various intervals is indicated at the bottom of the figure. Results are expressed as percentage with 95% confidence interval (95% CI). Secondary patency rates at 5 and 10 years were 89.8% and 82.9%, respectively in the crossover bypass group vs 97.0% and 94.9%, respectively in the direct bypass group (P = .03, hazard ratio: 3.7 with 95% CI: 1.1 to 9.8). Journal of Vascular Surgery 2008 47, 45-54.e1DOI: (10.1016/j.jvs.2007.08.050) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 5 Flowchart representing primary and secondary failures occurring in patients with crossover and direct bypass grafts. There were 30 primary failures of crossover bypass and eight primary failures of direct bypasses. Arterial flow was successfully maintained or restored by donor iliac angioplasty, thrombectomy, or femoral patch angioplasty in 20 failed crossover bypasses and in five failed primary direct bypasses. Secondary failures required 10 aortobifemoral grafts and one new crossover femorofemoral graft. Two major amputations were required in patients with failed direct or crossover bypass and unreconstructable distal arterial disease. Journal of Vascular Surgery 2008 47, 45-54.e1DOI: (10.1016/j.jvs.2007.08.050) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 6 Primary patency of crossover bypasses and direct bypasses analyzed in function of superficial femoral artery (SFA) run-off in the symptomatic leg. The number of patients at risk in each group at various intervals is indicated at the bottom of the figure. Results are expressed with 95% confidence interval (95% CI). In the crossover bypass group, primary patency rates at 5 and 10 years were 71.9% and 64.3%, respectively in patients presenting no or low-grade (<50%) stenosis of the SFA compared with 62.5% and 42.3%, respectively in patients presenting high-grade stenosis (≥50) or occlusion of the SFA (P = .04, hazard ratio: 2.0 with 95% CI: 1.04 to 5.0). In the direct bypass group, primary patency rates were not significantly correlated with SFA run-off with a 10-year patency of 95.8% in patients presenting no or low-grade stenosis of the SFA compared with 90.4% in patients presenting high-grade stenosis or occlusion of the SFA (P = .94, hazard ratio: 0.98 with 95% CI: 0.2 to 5.8). Journal of Vascular Surgery 2008 47, 45-54.e1DOI: (10.1016/j.jvs.2007.08.050) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions