Clinical Consequence of Bare-Metal Stent and Stent Graft Failure in Femoropopliteal Occlusive Disease

Abstract

The optimal role for bare-metal stents (BMS) and stent grafts (SG) in treating femoropopliteal occlusive disease (FPOD) is as yet undefined. Understanding the clinical consequences of failure can help guide initial treatment decisions. The goal of this study was to define the nature and frequency of adverse clinical events related to BMS and SG failure in FPOD. This is a single-institution retrospective review of the primary endovascular intervention for FPOD, treated with BMS or SG, from September 2007 through October 2011. Patient demographics, indications for intervention, anatomic characteristics, procedural details, clinical outcomes, and reintervention details were reviewed. Patients were excluded if they had any previous lower extremity interventions or inadequate follow-up. Of the 127 limbs from 97 patients that met the inclusion criteria, 67 were treated with BMS and 60 with SG. Follow-up averaged 551 days for BMS and 690 days SG. The indication for intervention was similar between groups (49% vs 68% claudication; P = .15). Baseline patient characteristics were similar between groups, with the exception of more TransAtlantic Inter-Society Consensus (TASC) D lesions (9 of 67 vs 26 of 60, P < .01) and chronic total occlusion (18 of 67 vs 35 of 60; P < .01) in the SG group. Freedom from reintervention of the index procedure was more likely with SG (28 of 67 vs 40 of 60, P < .01). For both groups, the indications for reintervention of the index procedure were prompted by changes in symptoms or physical examination findings rather than by abnormal findings on surveillance ultrasound imaging (9 of 39 vs 3 of 20). Only patients in the SG group presented with acute limb ischemia (0 vs 6, P < .01); however, the major adverse limb event rate was not different between groups (11 vs 10, P = .9). The 127 limbs needed 96 primary and secondary interventions during the course of the study. Including both primary and secondary interventions, only patients treated with SG presented with acute limb ischemia (0 vs 11, P < .1). Reinterventions are common in both groups; however, SG failure is more likely to present with acute limb ischemia than BMS failure. These observations should be carefully considered when treating FPOD with BMS or SG.