This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (26)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Revascularization  • Cardiovascular System  • Surgery  • Surgical Interventions  • Vascular Surgery  • Cardiovascular Intervention  • Alert me on articles by topic  Social Bookmarking   What's this?

Ian L. Gordon, MD,PhD; Robert M. Conroy, MD; Mahbod Arefi, MD; Jonathan M. Tobis, MD; Edward A. Stemmer, MD; Samuel E. Wilson, MD

Arch Surg. 2001;136:221-228.

Hypothesis  Patency after primary percutaneous transluminal angioplasty (PTA) and stenting of superficial femoral artery (SFA) occlusions is better than historical experience with PTA alone.

Design  Consecutive case series of primary PTA with stenting, and follow-up with duplex imaging every 6 months (mean ± SD follow-up, 32 ± 15 months).

Setting  Veterans Affairs medical center.

Patients and Methods  Patients were 57 previously untreated men with 71 limbs having chronic atherosclerotic SFA occlusion with suprageniculate reconstitution and patent tibial runoff. Critical ischemia (Society for Vascular Surgery [SVS] category, 4-6) was present in 7 (10%), the remainder had intermittent claudication only (SVS, 1-3).

Interventions  Guidewire recanalization followed by PTA, Wallstent deployment, and adjunctive thrombolysis as necessary; 19 limbs (27%) required thrombolysis to manage periprocedural thrombosis.

Main Outcome Measures  Cumulative patency, limb salvage, and complications.

Results  Length (mean ± SD) of occlusion was 14.4 ± 9.9 cm. Length of stented artery was 24.3 ± 11.1 cm. Ankle brachial index increased from 0.59 ± 0.14 to 0.86 ± 0.16 (P<.001) after stenting. One- and 3-year patencies were as follows: primary, 54.6% ± 6.3% and 29.9% ± 6.6%; assisted primary, 72.3% ± 5.6% and 59.0% ± 6.8%; and secondary, 81.6% ± 4.8% and 68.3% ± 6.5%. Three-year secondary patency when periprocedural thrombolysis was required was 35.7% ± 12.5% compared with 70.6% ± 7.4% for limbs not requiring periprocedural thrombolysis (P= .02); the differences in occlusion length and severity of ischemia were not significant between these 2 groups. Limbs undergoing adjunctive PTA during angiography 6 to 12 months after initial stenting had 63.0% ± 13.3% patency at 3 years compared with 100% patency in limbs not requiring PTA at 6 to 12 months angiography (P= .046). Periprocedural mortality and morbidity were 2.8% and 15.5%, respectively. Three of the 7 limbs with critical ischemia underwent amputation during follow-up compared with 2 (3%) of 64 limbs with functional ischemia (² test, P<.006). A mean of 1.8 endovascular interventions per limb were performed.

Conclusions  Percutaneous transluminal angioplasty and stenting yielded higher patency rates than historical controls undergoing PTA alone. When periprocedural thrombolysis is required, subsequent patency appears to be significantly worse. Poor results after PTA and stenting of limbs with critical ischemia and the need for additional endovascular therapy limit the technique's utility.

From the Departments of Surgery (Drs Gordon, Arefi, Stemmer, and Wilson) and Radiology (Dr Conroy), University of California, Irvine, Veterans Affairs Medical Center, Long Beach, Calif (Drs Gordon, Conroy, Arefi, Stemmer, and Wilson), and the Department of Cardiology, University of California, Los Angeles (Dr Tobis).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Current state of endovascular treatment of femoro-popliteal artery disease
Zeller
Vasc Med 2007;12:223-234.
ABSTRACT