24-month Secondary Patency Research Articles

Below knee bare nitinol stent placement in high-risk patients with critical limb ischemia is still durable after 24 months of follow-up

This study evaluated the durability of nitinol stent placement in high-risk patients with chronic critical limb ischemia (CLI) and infrapopliteal lesions after suboptimal balloon angioplasty. Between January 2006 and January 2009, 53 high-risk patients (24 women; mean age, 71.8 +/- 5.1 years) with CLI underwent infragenicular stent placement with a 4F sheath-compatible self-expanding nitinol stent. Patients had three or more serious cardiopulmonary comorbidities, including chronic obstructive pulmonary disease, congestive heart failure, coronary artery occlusive disease, American Society of Anesthesiologists score >/=3, previous myocardial infarction, coronary stent or bypass, or infection after peripheral revascularization. Endovascular therapy was performed in 30 stenoses and 23 occlusions in 53 patients. The mean stenosis length was 5.5 +/- 1.9 cm. The mean occlusion length was 6.5 +/- 2.9 cm. The mean follow-up was 24.1 +/- 7.3 months and consisted of clinical examination, ankle-brachial index (ABI) measurements, and duplex ultrasound imaging. Digital subtraction angiography was performed if restenosis or reocclusion was suspected. The technical success rate was 98.1%. The 24-month cumulative primary patency rate was 75.5%. During the follow-up, two patients underwent successful repeat angioplasty, and four patients required crural bypass. The 24-month secondary patency and freedom from amputation rates were 88.7% and 88.7%, respectively. The mean ABI increased significantly at 12 and 24 months (P < .001). Risk stratification to detect predictors that influenced the patency rate showed that proximal lesions had significant better patency than distal crural lesions (83.3% vs 65.2%, P = .04). The morphology of the lesions (stenoses vs occlusions, P = .88) did not seem to influence primary patency. Four patients died from nonprocedure-related causes during the follow-up, including lung cancer, myocardial infarction, and glioblastoma multiforme. No procedure-related deaths were recorded. The 2-year outcome of our series underscores the value of infrapopliteal nitinol stent placement as a durable bailout treatment option in high-risk CLI patients with suboptimal angioplasty.

Are there angiographic predictors of success for vein bypass to the peroneal artery?

In order to evaluate the effect of angiographic run-off upon peroneal artery autogenous vein bypass patency and subsequent limb salvage, 53 autogenous vein peroneal artery bypasses performed for ischemic tissue loss were reviewed. All preoperative angiograms were evaluated according to three separate angiographic scoring systems that previously had been designed to quantify the severity of runoff resistance. None of the three scoring systems predicted either early bypass occlusion and/or major amputation. The cumulative 18-month primary patency and 24-month secondary patency rates were 71% and 90%, respectively. The 24-month limb salvage rate was 81%. Initial and intermediate-term salvage of limbs with ischemic tissue loss can be achieved by peroneal artery bypass. Angiographic scoring systems were poor predictors of bypass failure or major amputation.