title: Acute and mid-term outcomes after treatment of multiple, recurrent restenoses of the lower limb arteries.
abstract: OBJECTIVE
  Recanalization of long segmental occlusions of femoropopliteal arteries can be achieved by angioplasty and implantation of nitinol stents with high procedural success rates. However, due to recurrent in-stent restenoses (ISR) some patients need repeated interventions and their intermediate success rates are uncertain.
  
  
  METHODS
  Patients who were treated in our center from March 2008 through February 2011 due to symptomatic ISR (as determined by Duplex sonography) were retrospectively included in the study. After endovascular treatment of their ISR, they were prospectively evaluated with regard to recurrent ISR of the target lesions.
  
  
  RESULTS
  A total of 36 limbs (=lesions) in 32 patients (69% male, mean age 69±9 years) were successfully treated by balloon-angioplasty. Adjunctive cutting balloons and drug eluting balloons were used in 78% and 8%, respectively. Mean follow-up was 326 days. Recurrent ISR occurred in 10 (28%) lesions, while 26 (78%) lesions showed no recurrence of ISR. In a multivariate logistic regression analysis, age, gender, cardiovascular risk factors, renal failure and medication with cilostazol were not significantly associated with recurrent ISR. Moreover, the number of previous interventions of the target lesions was not an independent predictor of recurrent ISR.
  
  
  CONCLUSIONS
  Patients with multiple recurrences of ISR seem to have the same prospects of acute and mid-term success for endovascular treatment as those with first presentation of ISR. However, this observation has to be confirmed by prospective, large scale studies with a longer follow-up period to determine the significance of endovascular intervention within the scope of different revascularization approaches for treatment of recurrent ISR.
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine, Münster, Hospital of the University of Münster, Münster, Germany - meyborm@ukmuenster.de.
authors.forename: M
authors.initials: M
authors.lastname: Meyborg
authors.forename: C
authors.initials: C
authors.lastname: Engelbertz
authors.forename: F
authors.initials: F
authors.lastname: Lüders
authors.forename: K
authors.initials: K
authors.lastname: Gebauer
authors.forename: N M
authors.initials: NM
authors.lastname: Malyar
authors.forename: H
authors.initials: H
authors.lastname: Reinecke
mesh_terms: D000368:Aged; D000497:Alloys; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D003251:Constriction, Pathologic; D054855:Drug-Eluting Stents; D005260:Female; D005263:Femoral Artery / Q000473:pathology* / Q000601:surgery; D006801:Humans; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000601:surgery*; D011150:Popliteal Artery / Q000473:pathology* / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014654:Vascular Patency / Q000187:drug effects
chemical_list: D000497:Alloys; C013616:nitinol