Patterns of Index Endovascular Compared With Surgical Revascularization for Femoropopliteal Disease in Patients With Claudication Using Medicare-linked Data.

Abstract

To compare outcomes of endovascular versus open infrainguinal bypass in patients with claudication. PAD research has focused largely on CLTI, yet 20% of patients present with claudication and may not improve with medical therapy alone. Durability of endovascular intervention remains uncertain. Patients undergoing bypass for femoropopliteal disease were propensity matched to endovascular procedures using demographics, cardiovascular comorbidities, and center volume quartiles. Primary outcomes (CLTI, MALE) were ascertained via VISION-Medicare linkage. Secondary outcomes included reintervention and mortality. Kaplan-Meier and Cox models quantified associations between intervention and outcome. Sensitivity analysis used inverse probability weighting and Fine-Gray models. Seven hundred twenty open bypass procedures were matched to 3259 endovascular procedures (median follow-up 2.8 y, IQR 1.6-4.4). Median age was 72 versus 70 years (open vs. endovascular, P<0.001); most patients were non-Hispanic White (91.1% vs. 85.6%, P<0.001) and male (74.4% vs. 61.3%, P<0.001). MALE rates were higher with endovascular intervention at 1 year (33.4% vs. 37.3%, P=0.015), but not at 3 (49.5% vs. 49.1%, P=0.172), or 5 years (57.0% vs. 59.1%, P=0.149). CLTI progression, reintervention rates, and mortality were similar at 5 years. Endovascular intervention was not associated with MALE (HR 1.13, 95% CI: 0.97-1.32), CLTI progression (HR 0.90, 95% CI: 0.72-1.13), reintervention (HR 1.13, 95% CI: 0.97-1.32), or mortality (HR 0.86, 95% CI: 0.66-1.12). Open bypass and endovascular intervention demonstrated similar long-term MALE and progression to CLTI through 5 years, suggesting endovascular intervention may offer comparable outcomes in appropriately selected patients with claudication.