Primary stenting of the superficial femoral and popliteal artery
| Autor: | David D. Dearing, Kaushal R. Patel, Fred A. Weaver, Steven G. Katz, John M. Compoginis, Mary A. Kamel |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Percutaneous medicine.medical_treatment Arterial Occlusive Diseases Constriction Pathologic Kaplan-Meier Estimate Femoral artery Prosthesis Design Risk Assessment Ischemia Risk Factors Angioplasty medicine.artery Alloys medicine Humans Vascular Patency Popliteal Artery Prospective Studies Aged Proportional Hazards Models Ultrasonography Aged 80 and over business.industry Patient Selection Critical limb ischemia Intermittent Claudication Middle Aged Popliteal artery Intermittent claudication Surgery Femoral Artery Radiography Treatment Outcome Female Stents Radiology medicine.symptom Claudication business Cardiology and Cardiovascular Medicine Angioplasty Balloon |
| Zdroj: | Journal of Vascular Surgery. 50(3):542-547 |
| ISSN: | 0741-5214 |
| DOI: | 10.1016/j.jvs.2009.04.019 |
| Popis: | ObjectivesOver the last decade, the number of endovascular procedures performed on the superficial femoral (SFA) and popliteal arteries (PA) has significantly increased. There is no consensus on the optimal form of intervention used in this arterial segment. While some have advocated balloon angioplasty alone, others have championed either selective or primary stenting of these lesions. It is the purpose of this study to determine the efficacy and durability of primary stenting of the superficial femoral and popliteal artery.MethodsAll patients undergoing peripheral angioplasty by a single vascular surgeon were prospectively enrolled in an Institutional Review Board-approved, primary-stenting protocol. During a 44-month period, all patients undergoing percutaneous transluminal angioplasty of the SFA or PA also received primary arterial stenting with bare, self-expanding nitinol stents. Patient demographics and risk factors were identified. TransAtlantic InterSociety Consensus (TASC) classifications were determined for all lesions. Loss of primary patency was said to have occurred when an occlusion or a 50% or greater stenosis in any treated arterial segment was diagnosed by arterial duplex or angiography. Only time to loss of primary patency was recorded. Kaplan-Meier survival curves were plotted and differences between groups tested by log rank method.ResultsBetween January 16, 2004 and August 13, 2007, 201 angioplasties with primary stenting were performed on 161 patients. One hundred twenty-three stents were placed for claudication, and 78 for critical limb ischemia. Forty-six segments treated were TASC A, 82 were TASC B, 38 were TASC C, and 35 were TASC D. Patient follow-up ranged from three to 1329 days (mean: 426 days). Primary patency rates for TASC A and B lesions were 79%, 67%, and 57% at 12, 24, and 36 months. For TASC C and D lesions, primary patency rates were 52.7%, 36%, and 19% at the same time intervals. Primary patency rates for TASC A and B lesions were significantly higher than for C and D lesions (P < .001). The limb salvage rate was 88.5% in patients with critical limb ischemia. Distal runoff did not influence patency (P = .827).ConclusionsPrimary stenting of the SFA and PA provides durable results in patients with TASC A and B lesions and may be an effective treatment strategy. This approach is significantly less effective when used in treating those with TASC C and D disease. Based on the results in this series, the use of primary stenting does not extend the anatomic limits of the current treatment recommendations for catheter-based intervention in patients with infrainguinal occlusive disease. |
| Databáze: | OpenAIRE |
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