RS06 - Percutaneous Transmural Arterial Bypass in Routine Practice: Our Two-year Experience

Objectives: Percutaneous transmural arterial bypass (PTAB) integrates principles of open surgical bypass with minimally invasive endovascular techniques to treat long-segment occlusions of the superficial femoral (SFA) and popliteal arteries. The DETOUR1 trial demonstrated favorable 1-year patency outcomes, with primary (PPR), primary-assisted (PAPR), and secondary patency rates (SPR) of 81±4%, 82±4% and 90±3%, respectively. Similarly, the DETOUR II trial reported acceptable 2-year patency, with PPR of 79±5%, PAPR of 78±5%, and SPR of 86±4%. However, real-world outcomes of PTAB outside clinical trials remains limited.

Methods: A retrospective analysis of patients who underwent PTAB within our health system was conducted from August 2023 until December 2025. Collected variables included patient demographics, perioperative details, and postoperative outcomes. Primary endpoints were PPR, PAPR and SPR assessed at 1, 3, 6, 12, 18 and 24 months. Statistical analysis was performed using Stata/MP 15.1 (StataCorp LLC., College Station, TX, USA).

Results: A total of 49 PTAB procedures were performed in 44 patients (61.4 % male, mean age 71±7.3 years). Indications included lifestyle-limiting claudication (53.1%), tissue loss (42.9%), and rest pain (4.0%). Mean treated SFA occlusion length was 306.7 ± 125.1 mm. Technical success was achieved in 100% of cases, and all patients were discharged on combined oral antiplatelet and anticoagulant therapy. Mean follow-up was 316.5 days (range 6-788 days).

PRR at 1, 3, 6 and 12 months was 97.8%, 82.1%, 66.7% and 42.9 % respectively. Corresponding PAPR was 100%, 87.2%, 72.7% and 66.7%. SPR was 100% at 3 months, 93.9% at 6 months and 90.5% at 12 months post-operatively. At 18 months (n=12), only one patient had primary patency (8.3%), while PAPR and SPR were 41.7% and 83.3%, respectively. Only three patients had 24-month follow-up, all of whom had required intervention to maintain patency. Overall, 16 stent occlusions occurred, 20 patients required intervention, and two patients underwent major amputation secondary to stent occlusion.

Conclusions: In this real-world cohort, PTAB was associated with lower primary and primary-assisted patency rates than those reported in the DETOUR trials. As this study, did not evaluate the efficacy of the device, these findings should be interpreted as descriptive real-world outcomes, and underscore the need for close post-procedural surveillance and timely reintervention.