Failed superficial femoral artery intervention for advanced infrainguinal occlusive disease has a significant negative impact on limb salvage.
OBJECTIVE
Endovascular treatment of superficial femoral artery (SFA) lesions is a well-established practice. The repercussions of failed SFA interventions are unclear. Our goal was to review the efficacy of SFA stenting and define negative effects of its failure.


METHODS
A retrospective chart review was conducted from January 2007 to January 2010 that identified 42 limbs in 39 patients that underwent SFA stenting. Follow-up ankle-brachial index and a duplex ultrasound scan was performed at routine intervals.


RESULTS
Mean patient age was 68 years (range, 43-88 years); there were 22 men (56%) and 17 women (44%). Intervention indication was claudication in 15 patients (36%), rest pain in seven patients (17%), and tissue loss in 19 patients (45%). There were 15 patients (36%) with TransAtlantic Inter-Society Consensus (TASC) A, nine patients (21%) with TASC B, five patients (12%) with TASC C, and 13 patients (31%) with TASC D lesions. The majority of lesions intervened on were the first attempt at revascularization. Three stents (7.7%) occluded within 30 days. One-year primary, primary-assisted, and secondary patency rates were 24%, 44%, and 51%, respectively. Limb salvage was 93% during follow-up. Seventeen interventions failed (40%) at 1 year. Of these, seven patients (41%) developed claudication, seven patients (41%) developed ischemic rest pain, and three patients (18%) were asymptomatic. During follow-up, three patients (7.7%) required bypass and three patients (7.7%) major amputation, one after failed bypass. All limbs requiring bypass or amputation had TASC C/D lesions. Thirty-day and 1-year mortality was 2.6% and 10.3%, respectively.


CONCLUSIONS
Interventions performed for TASC C/D lesions are more likely to fail and more likely to lead to bypass or amputation. Interventions performed for TASC C/D lesions that fail have a negative impact on limb salvage. This should be considered when performing stenting of advanced SFA lesions.
Department of Surgery, Loyola University Medical Center, Maywood, IL 60153, USA. oalnouri@lumc.edu
Omar
O
Al-Nouri
Monika
M
Krezalek
Richard
R
Hershberger
Pegge
P
Halandras
Andrew
A
Gassman
Bernadette
B
Aulivola
Ross
R
Milner
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D055109:Ankle Brachial Index; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D017211:Treatment Failure; D014654:Vascular Patency