Conversations in Interventional Cardiology - Evolving Endovascular Strategies for Long and Complex Femoropopliteal Lesions: Insights From DETOUR2-Evolving Endovascular Strategies for Long and Complex Femoropopliteal Lesions: Insights From DETOUR2

Evolving Endovascular Strategies for Long and Complex Femoropopliteal Lesions: Insights From DETOUR2

Video Transcription

Video Summary

This J-Sky discussion reviewed two papers on very long femoropopliteal lesions. Peter Schneider presented a meta-analysis of 28 studies (2,311 patients) showing that primary patency declines sharply as lesion length increases, with about 42% patency at three years for lesions >20 cm. Because evidence for these complex “D and D+” lesions is limited, treatment choices remain challenging.<br /><br />The second paper reported three-year DETOUR2 results for the PTAB/Detour system, a percutaneous fem-pop bypass strategy for heavily calcified, long CTOs and prior failures. In 202 patients, mean lesion length was 32.7 cm, one-year primary patency was 81.8%, three-year primary patency was 58.2%, secondary patency 96%, and 30-day freedom from major adverse events 93%. Deep vein thrombosis was uncommon (4.1%).<br /><br />The panel discussed technical requirements, including needing a proximal SFA “nub,” careful re-entry, anticoagulation considerations, and where PTAB may fit relative to open bypass and repeat endovascular therapy.

Asset Subtitle

Sahil A. Parikh, MD, FSCAI; Peter A. Schneider, MD; Ehrin J. Armstrong, MD, FSCAI; Jennifer A. Rymer, MD, MBA

Asset Caption

closed captions are computer-generated

Keywords

femoropopliteal lesions

primary patency

DETOUR2

PTAB/Detour system

long CTOs

deep vein thrombosis