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OBJECTIVE: Outcomes of SFA angioplasty/stenting procedures are variable and persistence of symptoms due to re-stenosis is common. Stenting is often utilized for suboptimal angiographic appearance following balloon angioplasty. However, whether stenting improves total flow lumen is still controversial. To explore this further, we examined SFA intra-luminal anatomy following either balloon angioplasty or stenting using intra-vascular ultrasound (IVUS).
METHODS: Patients with suspected SFA disease based on preoperative imaging studies were prospective recruited at a single academic institution. Only patients with primary SFA diseases were included. Following angioplasty and/or stenting based on the discretion of treating physicians, a completion angiogram was performed to confirm satisfactory results before an IVUS evaluation. Maximal stenosis was defined by the smallest luminal diameter on IVUS in the treated SFA. Percentage of maximal residual stenosis was defined by minimal luminal area (mm²) relative to the vessel area (mm²) at the area of maximal stenosis. The numbers of non-consecutive areas with >50% stenosis were also recorded. Pre and postoperative ABI measurements were compared.
RESULTS: Thirty patients were recruited and 13 patients received stenting in addition to angioplasty. All were male with an average age of 67 years (Range, 57-88 years). The majority of patients exhibited common risk factors for vascular disease such as active smoking (67%), hypertension (80%), and diabetes (64%). Twenty-two (73%) patients had TASC-C/D lesions including 18 TASC-D and 4 TASC-C, and there was no difference between the two groups. Interestingly, both groups had substantial residual stenosis, but no difference in the maximal residual stenosis was observed between the stenting (21.8%, ranging 10.7-35.4%) and the angioplasty groups (Mean 22.9%, ranging 10.4-34.5%). The angioplasty cohort, however, had significantly more non-consecutive areas of >50% residual stenosis (P 0.15 during follow-up with no difference between the two groups.
CONCLUSIONS: Intra-operative IVUS evaluation provides useful insight on the extent of residual stenoses following SFA interventions. Stent placement significantly increased total flow lumen. However, stenting did not improve focal areas with maximal residual stenosis comparing to angioplasty alone.