title: Outcomes following treatment of femoropopliteal in-stent restenosis: a single center experience.
abstract: OBJECTIVE
  The aim of this study is to describe a single-center experience with endovascular treatment of femoropopliteal in-stent restenosis (ISR).
  
  
  BACKGROUND
  Femoropopliteal artery stenting is associated with a significant risk of ISR. Data are limited on the optimal treatment strategy and associated outcomes.
  
  
  METHODS
  A single institution retrospective chart review study was performed for patients who underwent endovascular treatment of femoropopliteal ISR from January 2006 to October 2008. Clinical and procedural characteristics, angiographic findings, and 12-month primary and secondary patency rates were analyzed. Univariate analysis was performed to identify predictors of 12-month primary patency.
  
  
  RESULTS
  Twenty-two limbs were treated in 20 patients during the study period. Procedural success was achieved in 21 limbs (95.5%). Laser, balloon angioplasty, and excisional atherectomy were the primary therapy in 52.4%, 33.3%, and 14.3% of the cases, respectively. Adjunctive balloon angioplasty was performed after laser and excisional atherectomy in all cases. The mean length of ISR was 13.2 ± 11.3 cm with a significant proportion of cases (40.9%) having Type IV pattern of ISR. At 12 months, primary and combined primary-assisted and secondary patency rates were 47.6 and 61.9%, respectively. Of the 11 limbs that did not have secondary patency, 6 had mild or no symptoms, and, therefore, repeat intervention was not performed. There was one transmetatarsal amputation during the 12-month follow-up period. In this study, there was no significant predictor of 12-month primary patency.
  
  
  CONCLUSIONS
  Treatment of ISR remains challenging with significant risk of recurrent restenosis. Further research is required to improve long-term patency.
authors.affiliation: Division of Cardiovascular Medicine and The Vascular Center, University of California, Davis Medical Center, Sacramento, California, USA.
authors.forename: Khung-Keong
authors.initials: KK
authors.lastname: Yeo
authors.forename: Umer
authors.initials: U
authors.lastname: Malik
authors.forename: John R
authors.initials: JR
authors.lastname: Laird
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D017073:Atherectomy / Q000009:adverse effects; D002140:California; D003251:Constriction, Pathologic; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency