Abstract
To improve the patency rate for angioplasty in chronic occlusion of the superficial femoral artery by deploying stents after angioplasty. 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. 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-mm-diameter 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. 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.
Highlights
Title Angioplasty and stent placement in chronic occlusion of the superficial femoral artery: technique and results
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
Balloon angioplasty of superficial femoral arteries has been studied by several authors
Summary
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. The predictors of restenosis were analyzed by univariate and multiple logistic regression This prospective study was approved by the Research Committee of the Medical Center and informed consent was obtained from all involved patients. During the 4 years the study was in progress, all patients fitting the criteria seen in the interventional radiology section of our medical center were consecutively included, with the exception of nine patients: five patients either refused the procedure or did not show up for a scheduled procedure; one patient had nonpalpable (but patent) femoral pulses in whom an axillary approach was used; one patient had gangrene of several toes of the involved limb and it was determined that amputation was more critical than superficial femoral artery stent placement; extreme obesity in one patient made an antegrade femoral approach too hazardous; and one patient was on dialysis. The remaining limbs were categorized on clinical grounds, ankle pressures, and how far the patient could walk
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