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Increased Role of Drug-eluting and Self-expanding Stents in Patients with Severe Infrapopliteal Disease
Sikandar Z. Khan, MBBS, Mariel Rivero, MD, Linda M. Harris, MD, Maciej L. Dryjski, MD, Hasan H. Dosluoglu, MD.
SUNY at Buffalo, Buffalo, NY, USA.
Objectives: Balloon angioplasty (BA) remains the most commonly used intervention for infrapopliteal arteries, with use of stents reported in <5% of cases. We noted that stent use was more frequently needed to achieve adequate revascularization than reported. The goal of this study is to assess the use of stents in patients who underwent infrapopliteal interventions, and to see if there is any difference between drug-eluting stents (DES), and self-expanding stents (SES) after suboptimal infrapopliteal balloon angioplasty.
Methods: 279 patients (326 limbs) who underwent infrapopliteal angioplasty from 09/01/2002 to 12/31/2014 were included. Patency, limb salvage, amputation-free, and major adverse limb event (MALE)-free survival rates were compared.
Results: The technical success rate was 96.9%. 183 patients (213 limbs) had BA, 39 (42 limbs) had balloon expandable stents (5 bare, 37 DES) and 49 (61 limbs) had SES. 96% had CLI (91% tissue loss, 5% rest pain) and 77% were diabetic. There were more renal insufficiency (56% vs 31%, P<0.001), multilevel interventions (70% vs 52%, P=0.003) in the stented groups. The treated lesion length (9.2±7.9cm, 6.9±5.4cm, 9.7±7.7cm), occlusion length (5.9±4.9cm, 5.5±5.1cm and 4.4±2.8cm) in groups were similar. There were fewer total occlusions in BA group (35% vs 45% vs 48%, P=0.052l). Primary patency, secondary patency, limb salvage, and freedom-from MALE were all similar between the groups (Table).
Conclusions: Balloon angioplasty provides excellent outcomes in patients with long infrapopliteal occlusive disease, however, a third of patients require stent placement, especially those with chronic kidney disease, and those requiring multilevel revascularization. SES and DES are equally effective following suboptimal infrapopliteal balloon angioplasty for patency, limb salvage and avoidance of MALE.
Patency, Limb salvage and freedom from MALE rates in groups. | BA (N=213) | | DES (N=42) | | SES (N=61) | | P value | | 12 mo | 24 mo | 12 mo | 24 mo | 12 mo | 24 mo | | | Primary patency | 66±4% | 60±5% | 72±8% | 48±13% | 68±7% | 64±8% | 0.934 | | Secondary patency | 92±2% | 82±4% | 85±7% | 75±12% | 88±5% | 88±5% | 0.936 | | Limb salvage | 81±7% | 76±3% | 87±6% | 77±8% | 85±5% | 85±5% | 0.582 | | Freedom-from MALE | 70±7% | 69±4% | 81±7% | 73±8% | 78±6% | 78±6% | 0.388 |
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