Angioplasty and Stent Placement in Chronic Occlusion of the Superficial Femoral Artery: Technique and Results

Abstract

Abbreviations: ABI ϭ ankle/brachial index, OR ϭ odds ratio, UK ϭ urokinase PURPOSE: To improve the patency rate for angioplasty in chronic occlusion of the superficial femoral artery by deploying stents after angioplasty. MATERIALS AND METHODS:Angioplasty and stent placement were performed in 61 arteries in 48 male patients. The mean occlusion length was 13.5 cm and the mean stent length was 30 cm. Patency rates were analyzed at 6 months and at 1, 2, 3, and 4 years. The predictors of restenosis were analyzed by univariate and multiple logistic regression.RESULTS: Patency rates were 87% at 6 months, consisting of 74% primary, 6% primary assisted, and 7% secondary; 79% at 1 year, consisting of 47% primary, 19% primary assisted, and 13% secondary; 72% at 2 years, consisting of 36% primary, 26% primary assisted, and 10% secondary; 70% at 3 years, consisting of 26% primary, 22% primary assisted, and 22% secondary; and 63% at 4 years, consisting of 25% primary, 0% primary assisted, and 38% secondary. There was a 15% morbidity rate and one mortality as a result of retroperitoneal bleeding. Better patency rates were noted at all time intervals in diabetic limbs, 7-mm-diameter versus 10-mmdiameter stents, shorter obstructions and shorter stents, nonsmokers, in limbs in which urokinase was not necessary after stent deployment, and in limbs with an International Society of Cardiovascular Surgery (ISCVS) classification under 3. Patency rates were not affected by age, race, number of trifurcation vessels patent, experience in performing the procedures, and procedures requiring less time. By multivariate logistic analysis, the independent predictors of patency at 6 months were postprocedure ankle/brachial index (ABI) and shorter stent length; at 1 year, preprocedure ABI, shorter stent length, and the presence of diabetes; at 2 years, preprocedure ABI and the presence of diabetes; and at 3 years, the preprocedure ABI. CONCLUSIONS:The techniques used to reestablish antegrade flow in these superficial femoral arteries yielded a high success rate. In addition, the use of angioplasty with stents may improve patency rates over angioplasty without stents.A common cause of lower extremity claudication is arteriosclerotic occlusion of the superficial femoral artery. A recent analysis of leg arteriograms on 1,000 consecutive patients with lower extremity claudication from our medical center revealed that in patients with no previous surgical or radiologic intervention in the arteries of the

The “Safari” Technique to Perform Difficult Subintimal Infragenicular Vessels

“…The intraluminal recanalization in the treatment of a femoral occlusion longer than 5 cm is poor (45-55% at 12-24 months) [17][18][19], compared with the vein graft patency of 82% at 1 year [9] or 66-81% at 5 years [19][20][21][22]. The subintimal procedure is therefore preferable.…”

Cilostazol Reduces Target Lesion Revascularization After Percutaneous Transluminal Angioplasty in the Femoropopliteal Artery

“…However, the 1-year patency rate after PTA is low, particularly in the femoropopliteal artery (FPA), with a mean patency rate of 61%. [1][2][3][4][5] Target lesion revascularization (TLR) is required more frequently in the FPA than for the coronary arteries and hence, transcatheter treatment of the FPA is currently hampered by the high restenosis rate.…”

Subintimal angioplasty and stenting in chronic total femoropopliteal artery occlusions: Early- and mid-term outcomes

“…Other studies have reported the results of bail-out stenting strategies (stenting performed if only angioplasty alone fails) which reveal a mean primary patency rate of 55% at 12 months [25][26][27][28].…”