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Flush Superficial Femoral Artery (SFA) Occlusion does not alter stent patency but is associated with increased Profunda Femoris Artery (PFA) interventions
Lorena Gonzalez, george pisimisis, md, Neal R. Barshes, MD MPH, Peter Lin, Panos Kougias, MD, Carlos F. Bechara, MD MS.
Baylor College of Medicine, Houston, TX, USA.
INTRODUCTION: Inability to engage origin of the SFA makes endovascular intervention difficult to treat flush SFA occlusions. If successful, stenting could compromise flow into the PFA. We report our experience with endovascular treatment of flush SFA occlusions.
Methods: We retrospectively reviewed all SFA endovascular interventions from 2008 to 2011. Stent patency of flush SFA occlusions was compared to non-flush SFA occlusions. We examined whether stenting of flush SFA occlusions was associated with increased PFA interventions.
Results: We identified 164 SFA interventions, 31 cases were flush occlusions (18.9%). Successful stenting was performed in 24 cases (77.4%). Indication for surgery was claudication in most cases (90.3%). There was no significant difference in the incidence of diabetes, hypertension, cardiac disease, and smoking between the 2 groups. Primary, primary-assisted, and secondary patency is not statistically different between the 2 groups (see Kaplan Meier curves). Seven patients (29.2 %) required PFA intervention during a 3 year follow-up. Two were managed intraoperatively at the time of the SFA stenting due to complete PFA coverage. One with balloon angioplasty of the SFA stent struts and the other by stenting the PFA origin through the struts. Five cases required patch angioplasty into the PFA, two with partial SFA stent removal. Indication for intervention was progressive worsening of velocities in the PFA origin. In 3 cases it was due to neointimial hyperplasia from the SFA stent and not due to stent coverage of the PFA (See figure). These interventions were performed within 6 months of the SFA stenting in 3 cases and within one year in the remaining 2 cases.
Conclusion: Flush SFA occlusion can be treated with angioplasty and stenting with comparable patency rates to non-flush SFA occlusion. Due to the high rate of PFA intervention, we offer surgical bypass to treat flush SFA occlusions at our institution.
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