Palmaz stent placement in iliac and femoropopliteal arteries: primary and secondary patency in 310 patients with 2-4-year follow-up.

Henry, Michel; Amor, Max; Ethévenot, G; Henry, Isabelle; Amicabile, C; Beron, R; Mentre, B; Allaoui, Mohamed; Touchot, Nicolas

doi:10.1148/radiology.197.1.7568818

Cited by 230 publications

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“…9 Based on these reports, stent placement as the primary treatment for femoropopliteal occlusive disease is not recommended, but Henry et al recommend stenting if the results of PTA are sub-optimal and for dissections or restenosis. 8 PTA -stenting also has some advantages over bypass surgery, such as low morbidity and mortality, shorter recovery and preservation of the saphenous vein for future bypass surgery, especially in young patients. Because the present patient was 48 years old and had multivessel coronary artery disease, thus being a candidate for coronary artery bypass surgery in the near future, we elected to revascularize the severely stenosed left popliteal artery with percutaneous catheter intervention, even though it carries a high risk of restenosis and repeat intervention.…”

Section: Discussionmentioning

confidence: 99%

Fracture of Popliteal Artery Stents

Babalık

Gülbaran

Gürmen

et al. 2003

Circ J

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tent implantation in the peripheral arteries is a safe and effective treatment not only for obstructive diseases, but also non-obstructive conditions such as aneurysm formation. 1,2 More than 50% of all obstructive lesions are located in the femoropopliteal segment where they tend to be longer and have multiple coexisting atherosclerotic lesions at different levels. Surgical revascularization is the treatment of choice for these diffuse femoropopliteal stenoses and although percutaneous transluminal angioplasty (PTA) has a high risk of occlusion, it is the recommended primary treatment. Stent implantation for femoropopliteal occlusions is not recommended because of poor patency rates, and should only be considered for major dissections after PTA because stenting has been associated with acute thrombosis, stent embolization or migration, distal embolization by plaque contents, vessel rupture or dissection. [3][4][5][6] In addition to these acute complications, late stent restenosis remains an unresolved clinical problem. Although stent fracture occurs rarely, it may contribute to or cause late stent failure when implanted in arteries near or at flexion points in the peripheral arteries. Stent fracture has occurred after iliac arterial stenting 7 and we describe a case of fracture in overlapping stents implanted in the left popliteal artery. Case ReportA 48-year-old man was referred for coronary and peripheral arteriography. He reported left calf claudication of 3 years' duration that had progressively worsened in the past few months. His complaints were pain and numbness with mild exercise. He had had non-insulin dependent diabetes mellitus for 1 year and had smoked 1 pack of cigarettes per day for 33 years. On physical examination, both his lower limbs were pale and cool. His left femoral pulse was present, but the left popliteal and left lower extremity pulses were absent. Right femoral and popliteal pulses were present, and the distal pulses in right lower extremity were also palpable. The ankle -brachial index was 0.32 for the left limb. There was not any ulcer formation related to occlusive arterial disease on either leg.The diagnostic coronary and peripheral arteriography revealed 2-vessel coronary artery disease: a severe stenosis in the proximal segment of the left popliteal artery and 50% narrowing of the right popliteal artery. There was late filling of the vasculature distal to the severely narrowed left popliteal artery (Fig 1). We used a standard angioplasty technique from an antegrade, ipsilateral puncture of the left common femoral artery with an 8F sheath. The lesion was crossed Circ J 2003; 67: 643 -645 (Received November 14, 2001; revised manuscript received January 21, 2002; accepted February 15, 2002

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Section: Discussionmentioning

confidence: 99%

Fracture of Popliteal Artery Stents

Babalık

Gülbaran

Gürmen

et al. 2003

Circ J

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“…[17][18][19] Balloon-expandable stents such as Palmaz TM stents (Cordis, Johnson & Johnson, Haan, Germany) and Strecker TM stents (Boston Scientific, Ratingen, Germany) were also implanted at the femoro-popliteal axis and several single-centre series were published showing acceptable results for short lesions. [19][20][21][22][23][24][25][26] However, three randomized studies [27][28][29] comparing PTA alone and PTA and stenting with balloon-expandable stents reported no benefit for stenting and the risk of stent compression. These studies do not support balloon-expandable femoro-popliteal stenting as a primary approach.…”

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confidence: 99%

Current state of endovascular treatment of femoro-popliteal artery disease

Zeller

2007

Vasc Med

114

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Considerable advances have been made over the last decade in percutaneous technology for the treatment of atherosclerotic diseases in the femoro-popliteal arteries. While treatment strategies are well defined in the iliac segment, where angioplasty and stenting perform well in appropriately selected lesions, the search for a durable transcatheter therapy for femoro-popliteal lesions continues. Whereas balloon angioplasty (PTA) is the accepted therapy for short lesions, long diffuse lesions are still recommended for surgical treatment. However, attractive new technologies ranging from transcatheter plaque excision to laser ablation, rotational atherectomy, cryoplasty, brachytherapy, and placement of drug-eluting stents to simple angioplasty with drug-coated balloons may have the potential to replace femoro-popliteal bypass surgery as a treatment of choice for complex lesions. This article reviews the status of percutaneous endovascular techniques for the treatment of femoro-popliteal artery occlusive disease.Key words: angioplasty; percutaneous intervention; peripheral occlusive disease; popliteal artery; stent; superficial femoral artery Albert-Ludwigs-University Freiburg, Freiburg, Germany and Department of Angiology, Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany Address for correspondence: Thomas Zeller, Abteilung Angiologie, Herz-Zentrum Bad Krozingen, Südring 15, D-79189 Bad Krozingen, Germany. Tel: ϩ49 7633/4020; Fax: ϩ49 7633/402-8208; E-mail: thomas.zeller@herzzentrum.de defined as target lesion revascularization (TLR). If another lesion at the target vessel site but not the index lesion itself needs to be treated during follow-up this intervention is defined as target vessel revascularization (TVR). Superficial femoral artery and popliteal artery diseaseThe superficial femoral artery (SFA) extending to the proximal popliteal artery segment is the most commonly diseased vasculature. More than 50% of all PAD cases involve the SFA and popliteal artery. Femoro-popliteal disease is often characterized by long, diffuse lesions, long occlusions (as opposed to mild focal stenoses). The unique slow-flow and highresistance environment in the femoro-popliteal region creates a milieu that seems to increase the prevalence of de novo disease. The same issues that lead to accumulation of plaque within the femoro-popliteal region likely amplify the response to injury and may explain the high incidence of restenosis following traditional angioplasty. 9 Femoro-popliteal occlusive disease is still the Achilles heel of the vascular specialist.The durability of femoro-popliteal intervention can be predicted by the pre-procedural angiographic characteristics of the target lesion. The TASC I and the updated TASC II document 6 divided the femoropopliteal lesions into four categories (Table 1). TASC A lesions are more suitable for endovascular procedures, whereas surgery is recommended for TASC D lesions. The TASC document clearly states that it takes more evidence to make firm recommendations about the role of an...

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“…A review of 203 iliac Palmaz stent placements in 184 patients cited a 6-month restenosis rate of 0.5% and a 4-year patency rate of 86% [12]. Successful use of stents for isolated infrarenal stenosis of the aorta has occurred mostly in the settings of failed or technically difficult suboptimal PTA [13,14] and nonspecific aortitis [15].…”

Section: Discussionmentioning

confidence: 99%