Direct stent puncture technique for intraluminal stent recanalization in the superficial femoral and popliteal arteries in-stent occlusion: outcomes from a prospective clinical analysis of diabetics with critical limb ischemia.
OBJECTIVE
To evaluate the efficacy and safety of "Direct Stent Puncture" technique for intraluminal stent recanalization in the femoro-popliteal segments.


METHODS
A cohort of diabetics who had symptomatic in-stent occlusion of the superficial femoral or popliteal arteries underwent endovascular recanalization. After antegrade failure, direct stent puncture technique was performed. The primary end-point was to efficacy assessment, intended as technical success and clinical improvement. The secondary end-point was safety assessment, intended as free of complication rate.


RESULTS
Fifty-four patients (37 men; 73.6±8.5 years) underwent direct stent puncture technique, after several unsuccessful antegrade attempts to cross the occluded stent. Technical success for intraluminal stent recanalization was achieved in 53/54 (98.2%) of cases and failed in 1/54 (1.8%). Clinical improvement was obtained in 51/54 (94.4%) of cases, with regression of the clinical symptoms and improvement of the TcPO2, from 3±18 mmHg to 43±11 mmHg after 15 days (p<0.001). Free of complications rate was 92.5%. In 2/54 (3.7%) of cases distal embolization occurred, in 1/54 (1.9%) case a sudden vessel thrombosis was diagnosed after 12 hours and in 1/54 (1.9%) case hematoma at the stent puncture site was observed.


CONCLUSIONS
Direct Stent Puncture technique is an efficacy and safety option for intraluminal stent recanalization in the femoro-popliteal segment in-stent occlusion.
Foot & Ankle Clinic, Interventional Radiology Unit, Policlinico Abano Terme, Piazza C. Colombo 1, 35031-Abano Terme (PD), Italy. marianopalena@hotmail.com
Luis Mariano
LM
Palena
Marco
M
Manzi
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000379:methods; D048909:Diabetes Complications / Q000601:surgery; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000601:surgery; D011150:Popliteal Artery / Q000601:surgery*; D011446:Prospective Studies; D011677:Punctures / Q000379:methods*; D015607:Stents; D013848:Thigh / Q000098:blood supply / Q000601:surgery*; D016896:Treatment Outcome
Direct Stent Puncture technique; Retrograde recanalization; SFA recanalization; SFA stenting