PC158 Long-Term Outcomes After Endovascular Stent Placement for Symptomatic, Long-Segment Superficial Femoral Artery Lesions

Abstract

Endovascular intervention is commonly pursued for the treatment of symptomatic, long-segment superficial femoral artery (SFA) disease. The relative effectiveness and comparative long-term outcomes among bare-metal stents (BMS), covered stents (CS), and drug-eluting (DES) stents for long-segment SFA lesions remain uncertain. A retrospective cohort study identified consecutive patients with symptomatic SFA occlusions measuring at least 15 cm who received an endovascular stent (BMS, CS, or DES). The primary outcome of interest was patency, while secondary outcomes included postoperative presentation with acute limb ischemia (ALI), number of reoperations, and limb salvage. Patency rates were compared using time-to-event analysis and log-rank tests. From 186 patients that were identified, a total of 215 procedures were analyzed (BMS: 113 [52%]; CS: 75 [35%]; DES: 27 [13%]) with a median follow-up time of 56 months (although the follow-up for DES was less: median, 10 months; P < .001). There were no significant differences among the groups with respect to mean age, diabetes status, renal dysfunction, and lower extremity runoff (mean 2.0 ± 0.7 vessels). The mean length of the SFA lesion being treated in this series was 27 ± 8 cm (also similar across all groups, P = .165). Although primary and secondary patency rates were not significantly different among the stent types, DES is associated with an improved short-term primary-assisted patency, with 6-, 12-, and 24-month rates of 92%, 92%, and 83%, respectively. This is compared to 80%, 57%, and 47% for BMS, and 80%, 49%, and 41% for CS, respectively (log-rank test: P = .009; Fig 1). In comparing only BMS with CS, 5- and 8-year primary-assisted patency rates are also higher among BMS: 60% and 60% vs 33% and 33% for CS, respectively (P = .011; Fig 2). Zero DES patients have presented postoperatively with ALI compared to 3% of BMS patients and 13% of CS patients (P = .004). Similarly, the CS group had a higher rate of subsequent open revascularization (32%) compared with BMS (24%) and DES (7%; P = .038). Although long-term primary-assisted patency is greater in BMS as compared to CS, primary and secondary patency rates among all stent types are similar. CSs are associated with an increased risk of postoperative acute limb ischemia and subsequent open revascularization.Fig 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)