Early Results with the Use of Heparin-bonded Stent Graft to Rescue Failed Angioplasty of Chronic Femoropopliteal Occlusive Lesions: TASC D Lesions Have a Poor Outcome

• DOI: 10.1007/s00270-012-0400-6
• Publication Date: 2012-07-07T12:24:53Z
• Authors: Ganesh Kuhan; Said Abisi; Bruce D. Braithwaite; Shane T. R. MacSw...; Simon C. Whitaker; Said B. Habib
• Keywords: Adult; Aged, 80 and over; Male; Heparin; Anticoagulants; Arterial Occlusive Diseases; Drug-Eluting Stents; Comorbidity; Kaplan-Meier Estimate; Middle Aged; 3. Good health; Femoral Artery; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Chronic Disease; Retreatment; Humans; Female; Popliteal Artery; Angioplasty, Balloon; Aged; Proportional Hazards Models

To evaluate early patency rate of the heparin-bonded stent grafts in atherosclerotic long femoropopliteal occlusive disease, and to identify factors that affect outcome.Heparin-bonded Viabahn stent grafts were placed in 33 limbs in 33 patients during 2009-2010. The stents were deployed to rescue failed conventional balloon angioplasty. Mean age was 69 (range 44-88) years, and 67 % (22 of 33) were men. Most procedures (21 of 33, 64 %) were performed for critical limb ischemia (33 % for rest pain, 30 % tissue loss). Kaplan-Meier plots and Cox regression analysis were used to identify significant risk factors.The average length of lesions treated was 25 ± 10 cm, and they were predominantly TASC (Transatlantic Intersociety Consensus) D (n = 13) and C (n = 17) lesions. The median primary patency was 5.0 months (95 % confidence interval 1.22-8.77). The mean secondary patency was 8.6 months (95 % confidence interval 6.82-10.42). Subsequently, 4 patients underwent bypass surgery and 5 patients underwent major amputation. One patient died. There were 5 in-stent or edge-stent stenoses. Cox multivariate regression analysis identified TASC D lesions to be a significant risk factor for early occlusion (p = 0.035).TASC D lesions of femoropopliteal occlusions have poor patency rates with the use of heparin-bonded stent grafts after failed conventional angioplasty. Alternative options should be considered for these patients.