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Minimally invasive stents show some advantage over bypass in opening blocked leg arteries
Date:8/6/2013

low to keep up with demand, people experience PAD's most notable symptom leg pain when walking. As the disease progresses, patients may develop gangrene or open sores that threaten the limb.

Once the pain is serious and chronic, even without walking, doctors consider manually bypassing the blockages. In contrast to minimally invasive stenting, a so-called femoral-popliteal bypass requires a large incision to open the leg, and the surgical attachment of a piece of vein or a synthetic tube above and below the blockage to reroute blood flow.

The small study, just published, was conducted by analyzing records from 104 patients with PAD who either got a stent or a bypass operation at Johns Hopkins Bayview Medical Center between September 2005 and September 2010. The average age of patients in the study was 68 years.

Patients who received stents had a 31 percent risk of needing another procedure to restore blood flow within 24 months, while those who received a bypass had a 54 percent chance of needing another intervention. The researchers found that women were twice as likely as men to need a second operation.

Malas cautions that patients in the stent group may have had better outcomes because 77 percent of them had what were considered smaller blockages, while 73 percent of those who had bypass surgery had larger ones. Physicians use a somewhat subjective measure to choice a treatment, confounding efforts to tease out clear guidelines about when to use stents or bypass.

It is most difficult to determine which course of action to take with medium-sized blockages, Malas says, noting that in his study, patients with longer blockages were more likely to have had a stent in the past that failed, so their diseases may have progressed further along.

Malas says he tells his patients how important it is to adopt healthy habits exercising, eating properly, taking aspirin and medications to control elevated cholesterol and no
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Contact: Stephanie Desmon
sdesmon1@jhmi.edu
410-955-8665
Johns Hopkins Medicine
Source:Eurekalert

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