Patency Of Advanced Femoropopliteal Interventions Is Independent Of Stent Type
Edouard Aboian1, Eva Kazarian2, Yawei Zhang3, Raul J. Guzman3, Cassius Iyad Ochoa Chaar4.
1-yale, New Haven, CT, USA, 2Harvey Mudd College, claremont, CA, USA, 3yale, New Haven, CT, USA, 4Yale, New Haven, CT, USA.
Objectives:. The selection of endovascular treatment for patients with advanced femoropopliteal (FP) occlusive disease is mostly based on operator preference due to a lack of comparative studies and clinical trials. The aim of this study is to compare the patency of bare metal stents, drug eluting stents, and covered stents in the treatment of patients with severe FP occlusive disease. Methods: All procedures in patients undergoing treatment for isolated FP occlusive disease in the Vascular Quality Initiative (VQI) peripheral vascular interventions (PVI) registry were reviewed. Patients were stratified into three groups based on the stent type used: bare metal stents (BMS), stent grafts (SG) and drug eluting stents (DES). Baseline characteristics and outcomes of the three groups of patients were compared. Multivariable analysis to determine factors independently associated with primary patency was performed. Results: Total of 8318 patients and 8718 procedures had complete data available and were analyzed. The SG group have had more smokers and prior infrainguinal or inflow procedures.SG were used more frequently in TASC C/D and longer FP lesions (Table 1). One-year primary patency, mortality, or major amputation appeared no different among the groups. The reintervention rate at 1 year was slightly higher in SG group ( Table 1). A separate analysis comparing DES and BMS showed no difference in primary patency. On multivariable analysis of the entire cohort, decrease in primary patency was associated with CLTI (OR 0.49, CI 0.42-0.56), dialysis ( OR 0.48, CI 0.39-0.59) treatment length more than 25 cm (OR 0.62, CI 0.54-0.69), CHF (OR 0.59, CI 0.5-0.69)), diabetes (OR 0.82, CI 0.72-0.94), and age ( OR 0.9, CI 0.98-0.99) ). White race was associated with increased primary patency (OR 1.2, CI 1.06-1.47). Stent type was not associated with primary patency.
Conclusion: There was no effect of stent type on patency or major amputation rates when used for treating TASC C/D femorpopliteal occlusive disease. Stent grafts are utilized in the treatment of more complex FP lesions with slightly increased reintervention rates. Randomized comparative clinical trials may be needed to further delineate the utility of different stent types in treatment of advanced femoropopliteal lesions.
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| Demographics | Variable | Bare metal stents (N=5992) | Drug eluting stents (N=1011) | Stent grafts (N=1315) | P-value |
| Male sex | 61.4% (3681) | 64.2% (649) | 62.7% (824) | 0.210 | |
| White race | 78.8% (4719) | 78.6% (795) | 82.1% (1080) | 0.022* | |
| Age, years (mean ± SD) | 68.7±11.0 | 68.8±10.2 | 68.6±10.8 | 0.887 | |
| Comorbidities | Dialysis | 9.4% (563) | 9.1% (92) | 6.1% (80) | <0.001* |
| Diabetes | 56.2% (3369) | 57.3% (579) | 49.7% (654) | <0.001* | |
| History of Smoking | 80.4% (4817) | 82.5% (834) | 83.1% (1093) | 0.035* | |
| Hypertension | 88.6% (5309) | 88.3% (893) | 89.2% (1173) | 0.773 | |
| Coronary Artery Disease | 33.3% (1998) | 37.6% (380) | 32.8% (431) | 0.022* | |
| CHF | 20.0% (1197) | 20.0% (202) | 17.9% (213) | 0.211 | |
| Prior interventions | Prior infrainguinal procedure | 33.4% (2003) | 31.4% (317) | 45.1% (593) | <0.001* |
| Prior ipsilateral inflow procedure | 15.2% (911) | 14.2% (144) | 19.5% (256) | <0.001* | |
| Prior amputation | 5.7% (344) | 5.9% (60) | 4.0% (52) | 0.029* | |
| Indication | Claudication | 48.6% (3061) | 51.6% (546) | 51.5% (700) | 0.042* |
| Chronic limb threatening ischemia | 51.2% (3226) | 48.2% (510) | 47.8% (649) | 0.025* | |
| TASC Grade | A&B | 49.3% (3105) | 49.4% (523) | 36.5% (496) | <0.001* |
| C&D | 50.7% (3196) | 50.6% (535) | 63.5% (863) | <0.001* | |
| Treatment length | <= 15 cm | 57.8% (3645) | 53.3% (564) | 49.6% (674) | <0.001* |
| 15-25 cm | 19.2% (1210) | 23.0% (241) | 14.7% (200) | <0.001* | |
| => 25 cm | 23.0% (1446) | 23.9% (253) | 35.7% (485) | <0.001* | |
| Long term outcomes | Mortality | 10.0% (599) | 8.3% (84) | 8.9% (117) | 0.193 |
| Major amputation | 2.3% (146) | 2.2% (23) | 1.9% (26) | 0.596 | |
| Primary patency | 76.2% (4804) | 79.3% (839) | 76.4% (1038) | 0.091 | |
| Reintervention | 14.7% (926) | 12.7% (136) | 21.0% (285) | <0.001* |
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