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

Cardiovasc Intervent Radiol. 2012 Oct;35(5):1023-8. doi: 10.1007/s00270-012-0400-6. Epub 2012 Jun 14.

Abstract

Purpose: To evaluate early patency rate of the heparin-bonded stent grafts in atherosclerotic long femoropopliteal occlusive disease, and to identify factors that affect outcome.

Methods: 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.

Results: 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).

Conclusion: 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.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Angioplasty, Balloon
  • Anticoagulants / administration & dosage*
  • Arterial Occlusive Diseases / therapy*
  • Chronic Disease
  • Comorbidity
  • Drug-Eluting Stents*
  • Female
  • Femoral Artery*
  • Heparin / administration & dosage*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Popliteal Artery*
  • Proportional Hazards Models
  • Retreatment
  • Treatment Outcome
  • Vascular Patency

Substances

  • Anticoagulants
  • Heparin