Percutaneous Treatment of Long Superficial Femoral Artery Occlusive Disease: Efficacy of the Hemobahn Stent-Graft

Bray, Peter J.; Robson, W J; Bray, Abigail

doi:10.1177/152660280301000331

Cited by 34 publications

(31 citation statements)

References 54 publications

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“…Percutaneous angioplasty, because of the progress of the intraluminal and the extraluminal techniques and the availability of new materials, has demonstrated great efficacy in the treatment of CLI in terms of success rate, clinical outcome, and procedure-related complications [4,5,16].…”

Section: Discussionmentioning

confidence: 99%

The “Safari” Technique to Perform Difficult Subintimal Infragenicular Vessels

Gandini

Pipitone

Stefanini

et al. 2007

Cardiovasc Intervent Radiol

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The purpose of this study was to describe the efficacy of planned combined subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) to obtain the precise recanalization of the patent portion of a distal runoff vessel in critical limb ischemia (CLI) patients presenting long occlusions involving the popliteal trifurcation. Four patients at risk of limb loss due to long occlusions involving the leg vessel tree and not suitable for a surgical bypass were treated by the subintimal antegrade and retrograde (posterior tibial or anterior tibial artery) approach. The patent portion of the runoff vessel was previously assessed by magnetic resonance angiography (MRA) and directly punctured under Doppler ultrasound (US) guidance. A subintimal channel rendezvous was performed to allow snaring of the guidewires. Subsequently, a balloon dilatation was performed without stent deployment. All patients were successfully recanalized and had complete healing of the limb lesions. At the 12-month follow-up all patients showed clinical improvement with no major complications related to the procedure. This combined antegrade and retrograde subintimal approach is currently an excellent endovascular option in patients with long occlusions extending onto the leg vessels trifurcation and at risk of limb loss.

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Section: Discussionmentioning

confidence: 99%

The “Safari” Technique to Perform Difficult Subintimal Infragenicular Vessels

Gandini

Pipitone

Stefanini

et al. 2007

Cardiovasc Intervent Radiol

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“…[39][40][41][42][43][44] However, the early and midterm outcomes with the Hemobahn TM stent-graft (WL Gore and Associates, Inc., Flagstaff, AZ, USA) seem to be competitive with prosthetic surgical bypass with a reduced inflammatory vessel wall response. [45][46][47][48][49][50][51][52][53] Recently, the TCT (Trans Catheter Therapeutics) 2006 meeting presented promising single-centre registry data on the 1-year patency of the Viabahn TM (WL Gore and Associates, Inc.) application in long native SFA lesions and on in-stent lesions too being 90% and 65%, respectively. 54,55 Moreover, Saxon et al 56 reported a 79% primary patency rate and 93% secondary patency rate at the 4-year follow-up for lesions of an average length Ͼ10 cm, using Hemobahn or Viabahn stent grafts.…”

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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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“…Prosthetic stent-grafts, mostly utilizing ePTFE, have been shown to have poor 1-year patency rates. 4,5 Other designs employed saphenous vein as a lining, but patency rates were poor, and other logistical issues arose due to limited lumen diameter and concerns about tissue thickness.…”

Section: Discussionmentioning

confidence: 99%

Fatigue and In Vivo Validation of a Peritoneum-Lined Self-Expanding Nitinol Stent-Graft

Bastijanic¹,

Etscheidt²,

Sattiraju³

et al. 2014

Journal of Endovascular Therapy

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.P urpose: To assess the fatigue and in vivo performance of a new stent-graft incorporating bovine peritoneum lining that is designed for application in peripheral vascular occlusive disease. Methods: Bovine peritoneum-lined stent-grafts were subjected to accelerated in vitro pulsatile fatigue and axial/torsional fatigue testing designed to simulate 10 years of physiological strain on the devices. At specified times the devices were evaluated for stent fracture, suture failure, or tissue tearing. Seven dogs underwent bilateral common iliac artery (CIA) balloon angioplasty injury with unilateral placement of the peritoneum-lined stent-graft. Angiography and intravascular ultrasound were performed prior to treatment, after treatment, and prior to sacrifice at 30 days. Vessels were perfusion fixed and histologically evaluated at 5 regions: above stent, proximal stent, mid stent, distal stent, and below stent. Results: No evidence of stent, suture, or tissue failure was present during or after pulsatile and axial/torsional fatigue testing. At 3060.3 days after implantation, all vessels were patent. The average lumen area at explantation across stented vessels was 25.45 mm ). The mean neointimal area in peritoneum-lined stents was 2.0261.52 mm 2 , with a neointima:media ratio of 1.0360.50. These values were significantly lower in the above and below stent areas than in the stented regions, but there was no difference in either measure within the proximal, mid, or distal stent. Conclusion: The custom-designed peritoneum-lined stent-graft is promising for clinical peripheral applications due to its ability to resist relevant long-term physiological stresses and outstanding short-term patency rates in canine implantations.

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Percutaneous Treatment of Long Superficial Femoral Artery Occlusive Disease: Efficacy of the Hemobahn Stent-Graft

Abstract: Symptomatic long occlusive lesions of the SFA treated percutaneously with the Hemobahn stent-graft achieved good outcomes initially with a low complication rate. Primary and secondary patencies were similar to those reported for open synthetic femoropopliteal bypass procedures.

Cited by 34 publications

References 54 publications

The “Safari” Technique to Perform Difficult Subintimal Infragenicular Vessels

The “Safari” Technique to Perform Difficult Subintimal Infragenicular Vessels

Current state of endovascular treatment of femoro-popliteal artery disease

Fatigue and In Vivo Validation of a Peritoneum-Lined Self-Expanding Nitinol Stent-Graft

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