Early results with the use of heparin-bonded stent graft to rescue failed angioplasty of chronic femoropopliteal occlusive lesions: TASC D lesions have a poor outcome.
OBJECTIVE
To evaluate early patency rate of the heparin-bonded stent grafts in atherosclerotic long femoropopliteal occlusive disease, and to identify factors that affect outcome.


METHODS
Heparin-bonded Viabahn stent grafts were placed in 33 limbs in 33 patients during 2009-2010. The stents were deployed to rescue failed conventional balloon angioplasty. Mean age was 69 (range 44-88) years, and 67 % (22 of 33) were men. Most procedures (21 of 33, 64 %) were performed for critical limb ischemia (33 % for rest pain, 30 % tissue loss). Kaplan-Meier plots and Cox regression analysis were used to identify significant risk factors.


RESULTS
The average length of lesions treated was 25 ± 10 cm, and they were predominantly TASC (Transatlantic Intersociety Consensus) D (n = 13) and C (n = 17) lesions. The median primary patency was 5.0 months (95 % confidence interval 1.22-8.77). The mean secondary patency was 8.6 months (95 % confidence interval 6.82-10.42). Subsequently, 4 patients underwent bypass surgery and 5 patients underwent major amputation. One patient died. There were 5 in-stent or edge-stent stenoses. Cox multivariate regression analysis identified TASC D lesions to be a significant risk factor for early occlusion (p = 0.035).


CONCLUSIONS
TASC D lesions of femoropopliteal occlusions have poor patency rates with the use of heparin-bonded stent grafts after failed conventional angioplasty. Alternative options should be considered for these patients.
Queens Medical Centre, Nottingham University Hospitals, Nottingham, NG7 2UH, UK. gkuhan@nhs.net
Ganesh
G
Kuhan
Said
S
Abisi
Bruce D
BD
Braithwaite
Shane T R
ST
MacSweeney
Simon C
SC
Whitaker
Said B
SB
Habib
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D000925:Anticoagulants / Q000008:administration & dosage*; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D002908:Chronic Disease; D015897:Comorbidity; D054855:Drug-Eluting Stents; D005260:Female; D005263:Femoral Artery; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery; D016016:Proportional Hazards Models; D019233:Retreatment; D016896:Treatment Outcome; D014654:Vascular Patency
D000925:Anticoagulants; D006493:Heparin