title: Results of primary stent therapy for femoropopliteal peripheral arterial disease at 7 years.
abstract: OBJECTIVE
  Primary stenting is a well-established treatment option for femoropopliteal arterial disease. However, there is a paucity of data concerning the performance of this modality at ≥5 years. This study evaluated the long-term clinical and radiologic outcomes of primary stent therapy in patients with femoropopliteal arterial disease.
  
  
  METHODS
  A prospective data collection and analysis was conducted in patients undergoing primary stent placement in femoropopliteal lesions between September 2006 and September 2007. The EverFlex (Medtronic/Covidien, Plymouth, Minn) bare-metal stent was used. The primary outcome of this study was the primary patency rate. Secondary outcomes were secondary patency rate, amputation-free-survival (AFS), and freedom from target lesion revascularization (TLR). A Cox regression analysis identified risk factors for the primary and the secondary measure outcomes.
  
  
  RESULTS
  Included were 89 patients (102 stents). The prevalence of critical limb ischemia was 34% (n = 30). The initial angiography revealed a TransAtlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease C/D lesion in 31 patients (35%). Occlusions were present in 49 patients (55%), and the mean lesion length was 116 ± 33 mm. Popliteal artery disease was present in 39 treated limbs (35%). The primary patency rate at 1, 3, 5, and 7 years was 73%, 64%, 47%, and 33% respectively. At 7 years, secondary patency rate was 67%, freedom from TLR was 47%, and the AFS was 73%. Cox regression analysis revealed a decreased AFS among diabetic patients (hazard ratio [HR], 2.6; 95% confidence interval [CI], 1.08-6.28; P = .03), whereas secondary endovascular interventions showed a protective effect for AFS (HR, 0.14; 95% CI, 0.03-0.65; P = .01). Popliteal artery disease was identified as independent risk factor for secondary interventions (HR, 2.07; 95% CI, 1.05-4.06; P = .04) and TLR (HR, 1.99; 95% CI, 1.03-3.83; P = .04). Critical limb ischemia was associated with an increased incidence of surgical conversion owing to endovascular treatment failure (HR, 5.46; 95% CI, 2.44-12.17; P < .001).
  
  
  CONCLUSIONS
  This study found primary stenting was associated with acceptable clinical and radiologic long-term outcomes. Diabetes was associated with poor AFS, and popliteal artery involvement correlated with an increased need for reinterventions. AFS was better among patients undergoing secondary procedures.
authors: Department of Vascular and Endovascular Surgery, University of Münster, and the Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany. Electronic address: stavroulakis.konstantinos@yahoo.gr.
authors: Konstantinos
authors: K
authors: Stavroulakis
authors: Department of Vascular and Endovascular Surgery, University of Münster, and the Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany.
authors: Giovanni
authors: G
authors: Torsello
authors: Department of Vascular and Endovascular Surgery, University of Münster, and the Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany.
authors: Ayad
authors: A
authors: Manal
authors: Department of Vascular and Endovascular Surgery, University of Münster, and the Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany.
authors: Arne
authors: A
authors: Schwindt
authors: Department of Vascular and Endovascular Surgery, University of Münster, and the Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany.
authors: Christiane
authors: C
authors: Hericks
authors: Department of Vascular and Endovascular Surgery, University of Münster, and the Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany.
authors: Arne
authors: A
authors: Stachmann
authors: Department of Vascular and Endovascular Surgery, University of Münster, and the Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany.
authors: Eva
authors: E
authors: Schönefeld
authors: Department of Vascular and Endovascular Surgery, University of Münster, and the Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany.
authors: Theodosios
authors: T
authors: Bisdas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000792:Angiography; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D016638:Critical Illness; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D005858:Germany; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D019233:Retreatment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency