Endovascular stent-grafting in the treatment of superficial femoral artery occlusive disease.
OBJECTIVE
To explore the feasibility of using a flexible stent-graft in the treatment of superficial femoral artery occlusive lesions.


METHODS
Thirty-five patients (26 men; median age 65 years, range 41-85) with long-segment occlusions of the femoropopliteal arteries were treated with the Hemobahn endovascular prosthesis. The median occlusion length was 22 cm (range 4-40). Endografting was performed in conjunction with additional recanalization procedures as needed.


RESULTS
Primary recanalization and deployment of 47 Hemobahn endografts was successful in all cases; 12 patients had 2 devices implanted. The adjunctive recanalization techniques included balloon thrombectomy (n = 28), ring-stripper disobliteration (n = 7), local thrombolysis (n = 2), mechanical rotational thrombectomy (n = 2), local thromboendarterectomy and femoral bifurcation patch angioplasty (n = 14), iliac artery stenting (n = 3), and bypass grafting (n = 2). The median ankle-brachial index rose from 0.25 preoperatively to 0.87. Over an average 7-month follow-up (range 1-18), 10 (28.6%) occlusions occurred; 6 stent-graft thromboses were treated successfully with thrombectomy only. The other 4 occlusions were permanent. Life-table analysis documented cumulative primary and secondary patency rates of 73.2% and 82.6%, respectively, at 1 year.


CONCLUSIONS
Intraoperative use of the Hemobahn endograft is feasible and effective in restoring adequate distal perfusion in the short term, especially when combined with conventional recanalization techniques.
Bauermeister
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Department of General, Visceral, and Vascular Surgery, Klinikum Quedlinburg, Germany. klinikum-bauermeister@gmx.de
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery; D012086:Reoperation; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology; D014656:Vascular Surgical Procedures / Q000295:instrumentation*