title: Long-Term Primary Patency Rate After Nitinol Self-Expandable Stents Implantation in Long, Totally Occluded Femoropopliteal (TASC II C & D) Lesions.
abstract: BACKGROUND
  Endovascular therapy for long femoropopliteal lesions using percutaneous transluminal balloon angioplasty or first-generation of peripheral stents has been associated with unacceptable one-year restenosis rates. However, with recent advances in equipment and techniques, a better primary patency rate is expected. This study was conducted to detect the long-term primary patency rate of nitinol self-expandable stents implanted in long, totally occluded femoropopliteal lesions TransAtlantic Inter-Society Census (TASC II type C & D), and determine the predictors of reocclusion or restenosis in the stented segments.
  
  
  METHODS
  The demographics, clinical, anatomical, and procedural data of 213 patients with 240 de novo totally occluded femoropopliteal (TASC II type C & D) lesions treated with nitinol self-expandable stents were retrospectively analysed. Of these limbs, 159 (66.2%) presented with intermittent claudication, while 81 (33.8%) presented with critical limb ischaemia. The mean-time of follow-up was 36±22.6 months, (range: 6.3-106.2 months). Outcomes evaluated were, primary patency rate and predictors of reocclusion or restenosis in the stented segments.
  
  
  RESULTS
  The mean age of the patients was 70.9±9.3 years, with male gender 66.2%. Mean pre-procedural ABI was 0.45±0.53. One-hundred-and-seventy-five (73%) lesions were TASC II type C, while 65 (27%) were type D lesions. The mean length of the lesions was 17.9±11.3mm. Procedure related complications occurred in 10 (4.1%) limbs. There was no periprocedural mortality. Reocclusion and restenosis were detected during follow-up in 45 and 30 limbs respectively, and all were re-treated by endovascular approach. None of the patients required major amputation. Primary patency rates were 81.4±1.1%, 77.7±1.9% and 74.4±2.8% at 12, 24, and 36 months respectively. Male gender, severe calcification, and TASC II D lesion were independent predictors for reocclusion, while predictors of restenosis were DM, smoking and TASC II D lesions.
  
  
  CONCLUSIONS
  Treatment of long, totally occluded femoropopliteal (TASC II C & D) lesions with nitinol self-expandable stents is safe and is associated with highly acceptable long-term primary patency rates.
authors.affiliation: Division of Cardiology, Kasr Alaini Hospital, Cairo University, Egypt; Division of Cardiology, Aswan Heart Center, Aswan, Egypt. Electronic address: drmahmoudfarouk@yahoo.com.
authors.forename: Mahmoud Farouk
authors.initials: MF
authors.lastname: Elmahdy
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Piergiovanni
authors.initials: P
authors.lastname: Buonamici
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Trapani
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Valenti
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Migliorini
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Parodi
authors.affiliation: Division of Cardiology, Aswan Heart Center, Aswan, Egypt; Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: David
authors.initials: D
authors.lastname: Antoniucci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D000800:Angioplasty, Balloon; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014654:Vascular Patency
chemical_list: D000497:Alloys; C013616:nitinol
keywords: Femoropopliteal lesions; Nitinol self-expandable stents; Primary patency rate.