PATENCY RESULTS OF PERCUTANEOUS AND SURGICAL REVASCULARIZATION FOR FEMOROPOPLITEAL ARTERIAL-DISEASE

To estimate the patency results of percutaneous transluminal angioplas ty and bypass surgery in the treatment of femoropopliteal arterial dis ease, a Medlars search of the English-language medical literature was performed. Inclusion required that studies 1) report original data, 2) report patency with a life table or Kaplan-Meier analysis with the nu mber at risk or standard errors, 3) define patency as hemodynamic impr ovement, 4) report the distribution of covariates, and 5) not duplicat e other published material. Using a method based on the proportional-h azards model and the actuarial life-table approach, the results were a djusted for differences in case-mix of the study populations and paten cy was predicted for subgroups at various levels of risk for failure. The unadjusted pooled life tables yielded five-year patencies of 45% ( +/- 2%) for angioplasty, 73% (+/- 2%) for bypass surgery using a vein graft, and 49% (+/- 3%) for bypass surgery using a polytetrafluoroethy lene graft. Adjusted five-year primary patencies after angioplasty var ied from 12% to 68%, the best results being for patients with claudica tion and stenotic lesions. Adjusted five-year primary patencies after surgery varied from 33% to 80%, the best results being for saphenous v ein bypass performed for claudication. The authors conclude that pooli ng life-table data without adjustment for covariates can be misleading . Indication, lesion type, vein graft availability, and site of the di stal graft anastomosis need to be considered in predicting patency res ults of revascularization for femoropopliteal arterial disease.