Author + information
- Mahmoud F. Elmahdi1,
- Piergiovanni Buonamici2,
- Maurizio Trapani2,
- Renato Valenti2,
- Angela Migliorini2,
- Guido Parodi2 and
- David Antoniucci2
To evaluate the long term patency of nitinol self-expandable stents implanted in TASC C&D femoropopliteal lesions, and determine predictors of reocclusion or restenosis.
All patients treated by nitinol self-expandable stents for totally occluded long femoropopliteal lesions between January 2002 and December 2010 were reviewed. Patient demographics, clinical features, anatomic, and procedure factors were retrospectively analyzed. Outcomes evaluated included long-term primary patency rate at three years and predictors of reocclusion or restenosis.
The study group included 240 TASC C&D limbs in 213 patients (mean age 70.91±9.37years, male gender: 66.2%). One hundred-fifty four (72.3%) were suffering from claudication, while 59 limbs (27.6%) underwent treatment for critical limb ischemia, including 31limbs (14.5%) with tissue loss. All the lesions were total occlusion of the femoral artery ± the popliteal artery, with mean length of 17.94±11.38 cm, and 31.2% of the target lesions were heavily calcified. A total of 509 nitinol self-expandable stents were implanted (average, 2.1stents/limb), with 95.8% techniqual success. There was one procedure related mortality or amputation. Follow-up was available for 240 limbs at a mean of 36±22.6 months. No patient required a major amputation during this follow-up period. Thirty-nine limbs (16.2%) experienced reocclusion and twenty-one limbs (8.7%) experienced restenosis, all these limbs underwent reintervention during the follow-up time. Primary patency rates at 1, 2 and 3 years were 99.2%, 87.4%, and 74.4% respectively. Independent predictors for reocclusion were male gender, severely calcified and TASC D lesions, while diabetes, smoking and TASC D lesions were the predictors for restenosis.
Nitinol self-expandable stent implantation can be safely performed in long, totally occluded and heavily calcified femoropopliteal (TASC C& D) lesions, with highly comparable long-term primary patency rate to venous bypass surgery. TASC D lesion is the most important predictor for reocclusion or restenosis.
- 2013 American College of Cardiology Foundation