Abstract 9689: Nitinol Stents Implantation Improves Clinical Outcome After Endovascular Therapy in Hemodialysis Patients with Superficial Femoral Artery Lesions

Abstract

Background: Although endovascular therapy (EVT) has become widely performed for peripheral artery disease, high restenosis rate remains major problem after EVT to lesion of superficial femoral artery (SFA). Recently, it has been reported that nitinol stent implantation reduced restenosis in SFA after EVT in general population, however, the clinical outcome is little known in hemodialysis (HD) patients. The aim of this study was to investigate whether nitinol stent implantation improves clinical outcome after EVT to SFA lesions in HD patients. Methods: A total of 173 consecutive patients underwent nitinol stents implantation (NS group) were compared with 75 patients received stainless steel stents implantation in the preceding 5 years (SS group). We analyzed incidence of major adverse cardiovascular events (MACE) including target lesion revascurlarization (TLR), major amputation and death. To minimize the differences in both groups, a propensity-matched analysis using logistic model including male, age, traditional risk factors, critical limb ischemia (CLI) and TASC C+D lesions was performed. Each patients implanted with stainless steel stents were matched with up to two patients implanted with nitinol stents with two-digit propensity score (AUC = 0.63 using ROC analysis). Results: Baseline characteristics were comparable in both groups. On Kaplan-Meier analysis, 5-year freedom rate from MACE was higher in NS group than in SS group (51.8% vs. 24.4%, p<0.0001). After adjustment, nitinol stent implantation was an independent predictor of reducing MACE [HR 0.41, 95% CI 0.25-0.65, p=0.0002]. After the propensity score matching, 106 patients in NS group and 66 patients in SS group were matched. Still, freedom from MACE was higher in NS group than in SS group (47.7% vs. 24.6%, p<0.0001). Even after adjustment for other variables, implantation of nitinol stent predicted reduction of MACE (HR 0.47, 95% CI 0.28-0.79, p=0.0045). Nitinol stent implantation was also a predictor for not only preventing TLR (HR 0.35, 95%CI 0.18-0.68, p=0.0020) but also limb salvage (HR 0.26, 95%CI 0.07-0.96, p=0.043). Conclusion: Nitinol stent implantation improved clinical outcome after EVT compared to stainless steel stents in HD patients with SFA lesions.