Subintimal placement of covered stent versus subintimal balloon angioplasty in the treatment of long-segment superficial femoral artery occlusion.
BACKGROUND
Subintimal endovascular intervention has been used widely in the treatment of symptomatic superficial femoral artery (SFA) occlusion. The relative effectiveness of subintimal placement of a covered stent (CS) versus balloon-only subintimal angioplasty (SIA) remains uncertain.


METHODS
We performed a retrospective cohort study of consecutive patients with symptomatic SFA occlusions (>15 cm) who underwent subintimal endovascular intervention, either CS or SIA, in a single institution. Primary patency was the primary outcome. Secondary outcomes included complication rates, freedom from re-intervention, and limb salvage rates. Patency was ascertained with followup duplex or clinically.


RESULTS
We evaluated 57 patients in the SIA group and 31 patients in the CS group. At 1 year the SFA primary patency for the SIA and CS groups was 28% versus 75% (P < .001), whereas the primary assisted patency was 37% versus 84% (P < .001), respectively. Need for bypass was 13% versus 0% (P = .05) in the SIA and CS groups, respectively.


CONCLUSIONS
Placement of a covered stent improves patency after subintimal intervention for long SFA occlusion.
Kougias
Panagiotis
P
Division of Vascular Surgery and Endovascular Therapy, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston VAMC, Houston TX 77030, USA. pkougias@bcm.edu
Chen
Aaron
A
Cagiannos
Catherine
C
Bechara
Carlos F
CF
Huynh
Tam T
TT
Lin
Peter H
PH
D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D023821:Limb Salvage; D008297:Male; D015999:Multivariate Analysis; D011474:Prosthesis Design; D015607:Stents; D016896:Treatment Outcome; D017539:Tunica Intima / Q000601:surgery; D014654:Vascular Patency