Direct Stenting in Patients with Acute Lower Limb Arterial Occlusions: Immediate and Long-Term Results.
OBJECTIVE
The purpose of this study is to accentuate the efficacy of direct stenting (stent placement without predilatation of the lesion) in patients with acute lower limb arterial ischemia (ALLI).


METHODS
Between January 2010 and September 2015, 16 patients (11 men and 5 women) underwent direct stenting of acute arterial occlusions. All patients had contraindication for surgical revascularization or catheter-directed thrombolysis. According to SVS/ISCVS Classification, six patients had IIa and ten patients IIb ALLI. The occlusions were located in CIA, EIA, SFA, or popliteal artery. Mean follow-up time with clinical examination and color Duplex ultrasonography was 37.6 months (range 1-72). We analyzed the technical and clinical outcomes of the procedures, as well the complications and patency rates.


RESULTS
Technical success was achieved in all patients (16/16) and there was significant clinical improvement in 15 patients. There was neither distal embolization nor procedure-related complications. During the 6 years of follow-up, four patients died due to non-procedure-related causes and there were two minor and one major amputations. The primary patency rates and the amputation-free survival rates were 93.7 and 87% at 1 year, 75.2 and 71.2% at 3 years, and 75.2 and 62.3%, respectively, at 6 years.


CONCLUSIONS
Direct stenting may be a valuable alternative procedure for acute arterial occlusions in selected cases with high technical success and significant clinical improvement.


METHODS
Level 4, Case Series.
Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece.
Nikolaos
N
Galanakis
Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece.
Nikolaos
N
Kontopodis
Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece.
Ioannis
I
Peteinarakis
Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece.
Elias
E
Kehagias
Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece.
Christos V
CV
Ioannou
Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece. tsetis@med.uoc.gr.
Dimitrios
D
Tsetis
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001157:Arterial Occlusive Diseases / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology
Acute Limb Ischemia; Direct stenting; Embolism; Iliac artery; Nitinol stent; Popliteal artery; Recanalization; Superficial femoral artery; Thrombosis; Vascular intervention