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Occluded Superficial Femoral and Popliteal Artery Stents: Negative Impact on Bypass Target
Allan M. Conway, MBChB (Hons), MRCS (Eng), Khalil Qato, MD, Danielle Bottalico, Joanelle Lugo, MD, Gary Giangola, MD, Alfio Carroccio, MD.
Lenox Hill Heart & Vascular Institute of New York, New York, NY, USA.
OBJECTIVES:
Treatment of peripheral vascular occlusive disease involving the superficial femoral (SFA) and popliteal (POP) arteries is often initially approached with an endovascular technique rather than with a lower extremity bypass (LEB). Stent failure is known to occur, yet how this affects the initially available bypass target remains unclear. The purpose of this study was to identify whether occluded stents influence previously available lower extremity bypass targets.
METHODS:
We retrospectively investigated patients who had undergone stenting of an SFA or POP artery lesion from January 2009 to December 2013 to identify patients with occluded stents. Angiograms at the time of stent placement were analyzed to determine what would have been the optimal distal bypass site. Following occlusion of the stent, we assessed for patency of the previously available distal bypass site based on angiography or duplex ultrasonography. This population was also investigated for risk factors associated with loss of the bypass target.
RESULTS:
We identified occluded stents in 32 limbs in 30 patients. Primary patency at 1-year was 68.8%. Fourteen (47%) patients were male and mean age was 69.9 years (range, 53.3-86.4). Stenting was performed for claudication in 20 (62.5%), non-healing ulcer/gangrene in 10 (31.3%) and rest pain in two (6.3%) limbs. There were five limbs (15.6%) with TransAtlantic InterSociety (TASC) II A, 12 limbs (37.5%) with TASC B, nine limbs (28.1%) with TASC C and six limbs (18.8%) with TASC D lesions. Of the patients with occluded stents, 7 (21.9%) lost the bypass target. In one limb (3.1%) the target changed from above knee to below knee popliteal, in two limbs (6.3%) from above knee popliteal to tibial, and in four limbs (12.5%) from below knee popliteal to tibial artery. Eleven patients (34.4%) required LEB during follow up, nine of which were initially treated for claudication. Of the 28 variables investigated for an association with loss of bypass target we identified four that were significant.
CONCLUSIONS:
SFA and POP artery stent occlusion can affect target vessels in patients who may require subsequent LEB. This should be considered when performing stenting, especially in those with claudication.
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