title: High incidence of restenosis/reocclusion of stents in the percutaneous treatment of long-segment superficial femoral artery disease after suboptimal angioplasty.
abstract: OBJECTIVE
  To evaluate the efficacy of intravascular stents used to treat long-segment stenoses and occlusions of the superficial femoral artery (SFA) after suboptimal angioplasty.
  
  
  METHODS
  Fifty-eight limbs in 55 patients who underwent stenting of the SFA were identified from a vascular registry. Indications for stent placement after suboptimal PTA included flow-limiting dissection, residual pressure gradient (> 15 mm Hg) or stenosis (> 30%), or failure to establish initial patency. Lesion length ranged from 6 to 35 cm (mean, 16.5 cm). Endpoints for primary patency were: restenosis of > 50%, reocclusion, or diminution of the postprocedure ankle-brachial index greater than 0.15.
  
  
  RESULTS
  The mean ankle-brachial index improved from 0.48 +/- 0.19 to 0.71 +/- 0.23 (p = 0.001). Primary patency rates by Kaplan-Meier estimates at 1 month, 6 months, and 1 year were 88%, 47%, and 22%, respectively. Secondary patency rates were 94% at 1 month, 59% at 6 months, and 46% at 1 year. The median time to reaching an endpoint of restenosis or reocclusion was 6 months primarily and 9 months secondarily. Clinical improvement at the time of latest follow-up occurred in 56% of patients (mean, 13.8 months). Periprocedural complications occurred in 24.5% of patients with the first intervention. The only factor that favorably influenced outcome was improvement in clinical category after the procedure (p = 0.001).
  
  
  CONCLUSIONS
  There was a high incidence of restenosis and reocclusion with long-segment SFA disease that required stents to achieve initial success. Despite close surveillance and reintervention, anatomic patency at 1 year was poor. However, clinical benefit was maintained in the majority of patients. The outcome was similar in the claudication population compared with those who had limb-threatening ischemia. Percutaneous revascularization of long-segment SFA disease requiring stents should be reserved for patients with critical limb ischemia for which no reasonable surgical alternative exists.
authors.affiliation: Department of Vascular Medicine, The Cleveland Clinic Foundation, USA.
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Gray
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Sullivan
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Childs
authors.forename: Jess R
authors.initials: JR
authors.lastname: Young
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Olin
mesh_terms: D017130:Angioplasty; D050197:Atherosclerosis / Q000601:surgery / Q000628:therapy*; D003251:Constriction, Pathologic; D003925:Diabetic Angiopathies / Q000601:surgery / Q000628:therapy; D005260:Female; D005263:Femoral Artery / Q000473:pathology; D006801:Humans; D007511:Ischemia / Q000628:therapy; D008297:Male; D011474:Prosthesis Design; D012008:Recurrence; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency