Long term clinical and functional venous outcomes after endovascular transvenous femoro-popliteal bypass

Roberts Rumba (Coresponding Author), Dainis Krieviņš, Janis Savlovskis, Natālija Ezīte, Indulis Kukulis, Eva Petrošina, Ludovic R.L. Mouttet, Aigars Lācis, Christofer K. Zarins

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: Peripheral artery disease is widespread in Western societies affecting around 13% of the population above 50 years of age. Despite recent improvements of endovascular treatment, open surgical bypass is still recommended as the treatment of choice for long segment TASC D lesions. The DETOUR procedure was introduced as an endovascular alternative in cases of long-segment superficial femoral artery occlusion. This unconventional technique raises several questions regarding the effect of the bypass graft on femoral venous physiology.

Methods: We conducted a 3-year follow up study of subjects enrolled and treated in the prospective, multi-center DETOUR study at the Pauls Stradins clinical university hospital, Riga, Latvia. In total, 52 consecutive patients (54 procedures) were enrolled in this study from 2015 until 2019. We performed Venous Clinical Severity Score (VCSS) and Villalta (VS) score assessments, duplex ultrasound measuring femoral and popliteal vein diameters, venous occlusion plethysmography and digital photoplethysmography to assess and compare venous physiology at baseline and at follow-up visits every 6 months.

Results: At baseline mean femoral vein diameter was 11.1mm (SD=1.5). At 36-months following intraluminal stent graft placement, mean femoral vein diameter was 11.1 mm (SD=1.7) with no evidence of enlargement of the femoral vein (p=0.2). Popliteal vein diameter was not significantly changed during 24-months of follow up (p=0.12) but showed a small (0.02mm) statistically significant decrease in diameter at 36-months compared to baseline. During the study period, only one patient (1.9%) developed clinically significant ipsilateral DVT 1-month after surgery. Clinically silent femoral venous thrombosis was documented in 8 legs during 36 month follow up. In one case the thrombus was occlusive and in 7 cases the thrombus was non-occlusive. At baseline, 48 of 52 patients (92%) had no or minor venous symptoms ((VCSS 0-2) with clinically significant venous symptoms in only 4 patients ((VCSS ≥3). At one-month follow-up, the venous clinical severity score increased in all patients compared to baseline. At 6-month follow up, the VCSS had returned to baseline in the majority of patients with no significant changes during the 3-year follow up period. At baseline, all patients had a Villalta score of 0-2 indicating minor or no venous symptoms (mean 0.4 (SD 0.7)). At the 1-month follow-up visit 3 patients (5.8%) had a VS ≥ 3 (two patients had a score of 3 and one patient a score of 4), indicating significant venous symptoms. At the 6-month visit and thereafter, all the VS in all patients had returned to baseline. Transvenous endovascular procedure did not significantly alter venous physiology in treated leg.

Conclusions: Percutaneous transvenous femoropopliteal bypass provided safe and effective lower-extremity revascularization with minimal effect on long-term venous function. The femoral and popliteal vein remained patent with no compensatory enlargement in response to the presence of the bypass graft within the femoral vein. During 3-year follow up there were no significant changes in venous symptom scores or physiologic function.
Original languageEnglish
Pages (from-to)509 -516
JournalInternational Angiology
Issue number6
Publication statusPublished - Dec 2022

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 1.1. Scientific article indexed in Web of Science and/or Scopus database


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