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Stenting bests surgery for perioperative morbidity, mortality in de novo common femoral artery stenosis
Endovascular therapy, compared with surgery, was associated with significantly lower perioperative morbidity and mortality in patients with de novo atherosclerotic lesions of the common femoral artery, but comparable mid-term clinical, hemodynamic and morphological outcomes, according to new data from the TECCO trial.
Researchers analyzed 117 patients with de novo atherosclerotic lesions of the common femoral artery who were randomly assigned to undergo stenting (n = 56) or surgery (n = 61) from February 2011 to September 2013 at 17 centers in France. The mean age was 68 years and the majority were men. The median follow-up was 2 years.
The primary outcome of morbidity and mortality within 30 days was 12.5% in the stenting group vs. 26% in the surgery group (OR = 2.5; 95% CI, 0.9-6.6). A per-protocol analysis showed a similar trend of a lower primary outcome rate in the group assigned stenting.
“The difference in primary outcome events between the two groups was driven by a trend toward an increase in local complications in the surgery group, especially delayed wound healing,” Yann Gouëffic, MD, PhD, from University Hospital of Nantes, France, and colleagues wrote.
Patients who underwent stenting also had a significantly lower mean duration of hospitalization: 3.2 days vs. 6.3 days (P < .0001).
However, at 2 years, the researchers reported no difference between the groups in the primary sustained clinical improvement rate (stenting, 74.8 vs. surgery, 76.1; OR = 1.1; 95% CI, 0.5-2.5). In addition, there were no significant differences in mortality (HR = 1.3; 95% CI, 0.3-5.7), target lesion revascularization (HR = 0.99; 95% CI, 0.35-2.86), target extremity revascularization (HR = 1.3; 95% CI, 0.5-3.1) and primary patency (HR = 0.79; 95% CI, 0.25-2.5).
Also at 2 years, Rutherford category and ankle-brachial index were significantly improved after stenting or surgery, with no difference between the groups.
In other results, three patients assigned to undergo stenting required intraoperative conversion to surgery. Common femoral artery lesion types were similar between the two treatment groups. Most lesions treated were classified as type 3.
Surgery was performed based on the operator’s routine technique. In the stenting group, type 1 and 2 lesions were generally treated with the latest-generation self-expandable stents and type 3 lesions were generally treated with balloon-expandable stents or self-expandable stents in the case of superficial femoral artery occlusion.
“Common femoral artery atherosclerotic lesions currently remain one of the last limitations for the adoption of endovascular repair as the first-line treatment for infrainguinal atherosclerotic disease. In our trial, we observed that stenting in such patients reduced perioperative morbidity and mortality, and was associated with a similar 2-year outcome compared with surgery,” the researchers wrote. – by Katie Kalvaitis
Disclosure: The researchers report no relevant financial disclosures.