Is Above Knee Bypass Surgery Defunct?

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George H. Meier, III, MD, Hosam F. El Sayed, MD, Bernardo Mendoza, MD, Marc H. Glickman, MD, Martin A. Fogle, MD, F. Noel Parent, MD, Gregory A. Barber, MD, Gordon K. Stokes, MD, Peter M. Moy, MD, Jean M. Panneton, MD.
Eastern Virginia Medical School, Norfolk, VA, USA.

BACKGROUND:
The expansion of endovascular options for the treatment of infrainguinal arterial vascular disease has resulted in a dramatic change in the standards applied for the care of these patients. Traditional open repairs have been significantly impacted by these endovascular alternatives. This study was undertaken to review trends in endovascular versus open repair over the past 7 years
METHODS:
All procedures done between 1997 and 2003 for a diagnosis of infrainguinal arterial vascular disease at four hospitals in Norfolk, Virginia were reviewed and categorized as open or endovascular. Procedures that combined open and endovascular (excluding diagnostic angiography alone) were categorized as endovascular. Statistical analysis was using Student’s t-test with significance defined as P < .05.
RESULTS:
Between January, 1997 and December, 2003 a total of 5635 infrainguinal procedures were identified. Of these, 942 were classified as femoral-popliteal open bypass (FPB), 1091 as femoral-tibial open bypass (FTB), and 1569 as endovascular (EV). The maximum number of procedures was 937 in 2000 and the lowest was 668 in 2002. The maximum for FPB was 162 in 2000 with a minimum of 94 in 2003. For FTB, the maximum was 356 in 1998 with a minimum of 101 in 2003. For EV, the maximum was 493 in 2003 with a minimum of 72 in 1997. These trends were consistent over time, with a statistically significant decrease in open versus endovascular procedures over this time period (P < .001).

CONCLUSIONS:
Open infrainguinal bypass surgery appears to be decreasing linearly with time, replaced by endovascular treatment. This data further reinforces the need for vascular surgeons to acquire endovascular skills as endovascular options grow for infrainguinal disease.