Reestenosis asintomáticas de stents de arteria femoral superficial: ¿tratamiento endovascular o manejo conservador?

Abstract

ObjectiveTo compare the clinical outcomes of asymptomatic >70% in-stent restenosis in the superficial femoral artery (SFA) treated using an endovascular procedure or conservative treatment. PatientsA historical cohort study was performed on patients with femoral artery stent with an asymptomatic in-stent restenosis of 70-99% from January 2010 to December 2015. The patients were divided into two groups: conservative management vs. endovascular treatment. Material and methodsThe variables compared were, limb salvage and critical ischaemia or limiting claudication free survival rates (<250m) from initial stent treatment until the appearance of critical ischaemia or major amputation (log-rank, Kaplan Meier). Primary patency and assisted primary patency were analysed. Results and conclusionsA total of 23 >70% in-stent restenosis were diagnosed in 20 patients who had a mean age of 78 years old (SD 9.6). The mean follow-up was 30.1 months. Medical (aspirin and statins) and endovascular treatment was received by 12 patients (52.2%), and 11 patients (47.8%) received medical treatment only.No differences were seen in limb salvage.Critical ischaemia or limited claudication free survival rates were higher in the conservative treatment group than in the endovascular group (P=.031).Primary patency was 14.2 months (95% CI: 8.2-20.2), and assisted primary patency was 65.5 months (95% CI: 57.4-77.5).In our experience, treatment of severe asymptomatic lesions of in-stent stenosis in the SFA does not reduce the risk of amputation, critical ischaemia or limiting claudication. Conservative treatment could be a good option in asymptomatic patients, without increasing the risk in amputation and critical ischaemia.