Intravascular ultrasound evidence for stabilization of compensatory enlargement of the femoropopliteal segment after endograft placement.
OBJECTIVE
To document whether the vasodilatory response seen at the anastomotic segment 6 months after placement of a balloon-expandable endograft in the femoropopliteal segment progresses between 6 and 24 months.


METHODS
Twelve patients (9 men; median age 65 years, range 47-75) treated with an investigational polytetrafluoroethylene (PTFE) endograft for obstructive disease of the femoropopliteal segment were studied with intravascular ultrasound (IVUS) immediately after placement and at 6 months (first follow-up period) and 24 months (second follow-up period). Matched IVUS cross sections derived from the endograft and the anastomotic segment were analyzed for changes in lumen (LA), vessel (VA), and plaque areas (PLA).


RESULTS
Five patients had complete IVUS surveillance at both the first (mean 8 months, range 7-9) and second (mean 25 months, range 23-26) follow-up periods; 1 patient was lost to follow-up during the second interval, and another 6 were excluded owing to graft occlusion (n = 4) or no IVUS surveillance available (n = 2) during the second follow-up period. Matched IVUS cross sections derived from the endograft showed no significant change in LA during both follow-up periods (-8% and +1%, respectively). There was no evidence for intimal hyperplasia or endograft recoil. During both follow-up periods, IVUS cross sections derived from the anastomotic segment revealed significant increases in LA (+37% and +8%, respectively) and VA (+26% and +6%, respectively) (both p < 0.05). The change in PLA during both follow-up periods was not significant (+13% and +3%, respectively).


CONCLUSIONS
The PTFE endograft seems to inhibit both intimal hyperplasia and constrictive remodeling. The short-term (6-month) vascular dilatory response seen at the anastomotic segment tends to stabilize at 2 years. Therefore, this endovascular anastomosis acts as an "ideal" end-to-end anastomosis.
Hagenaars
T
T
Department of Experimental Echocardiography, Erasmus Medical Center Rotterdam, The Netherlands.
Gussenhoven
E J
EJ
Athanassopoulos
P
P
Pattynama
P M
PM
van Sambeek
M R
MR
D000368:Aged; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000628:therapy; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging* / Q000601:surgery; D005342:Fibrinolysis / Q000187:drug effects; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging* / Q000601:surgery; D013997:Time Factors; D018084:Ultrasonography, Interventional