Percutaneous transmural arterial bypass in routine practice: Our 2-year experience.

Abstract

Percutaneous transmural arterial bypass (PTAB) (Endologix) integrates principles of open surgical bypass with minimally invasive endovascular techniques to treat long-segment occlusions of the superficial femoral artery and popliteal artery. DETOUR1 (DETOUR I Clinical Study for Percutaneous Femoropopliteal Bypass) demonstrated favorable 1-year patency outcomes, with a primary patency rate (PPR), primary-assisted patency rate (PAPR), and secondary patency rate (SPR) of 81 ± 4%, 82 ± 4%, and 90 ± 3%, respectively. Similarly, the following DETOUR2 trial reported acceptable 1-year patency, with a PPR of 72.1%, PAPR of 77.7%, and SPR of 89.0%. However, outcomes of PTAB outside of the DETOUR clinical trials remain limited. A retrospective analysis of patients who underwent PTAB within our health care system was conducted from August 2023 to December 2025. Collected variables included patient demographics, perioperative details, and postoperative outcomes. Primary end points were PPR, PAPR, and SPR assessed at 1, 3, 6, 12, 18, and 24 months. A total of 49 PTABs were performed in 44 patients (61.4 % male; mean age, 71.0 ± 7.3 years). The mean treated superficial femoral artery occlusion length was 303.0 ± 125.1 mm. Technical success was achieved in 100% of cases, and all patients were discharged on combined oral antiplatelet and anticoagulant therapy. The mean follow-up duration was 312 days (range, 6-788 days). PPRs at 1, 3, 6, and 12 months were 97.8%, 84.6%, 60.6%, and 47.6%, respectively. Corresponding PAPRs were 100%, 87.2%, 69.7%, 71.4%, respectively, and SPRs were 100%, 100%, 90.9%, and 90.5% at the same intervals. At 18 months (n = 12), only one patient had primary patency (8.3%); the PAPRs and SPRs were 41.7% and 83.3%, respectively. Only three patients were present for the 24-month follow-up, all of whom had required intervention to maintain patency. Overall, 16 stent occlusions occurred, 20 patients required intervention, and 2 patients underwent major amputation secondary to stent occlusion. The PTAB device in our experience was associated with lower PPRs and PAPRs than those reported in the DETOUR trials. These findings underscore the need for close postprocedural surveillance and timely reintervention in patients who undergo PTAB.