Results of superficial femoral artery stenting in patients with chronic steno-occlusive disease

Resumen

Objective. To analyse clinical outcome after failure of endovascular stenting of the superficial femoral artery (SFA) in patients with steno-occlusive lesions. Material. A prospective study including patients with atherosclerotic disease treated between January 2007 and December 2013 with self-expansible stents in the superficial femoral artery (n=194). Excluded patients with steno-occlusive lesions affecting also iliac arteries. Methods. Analyzed the demographic and hemodynamic characteristics before and after the pro-cedure, and their clinical consequences on the limb. The following variables were taken into con-sideration: gender, clinical state (Leriche – La Fontaine Classification), location of lesion (TASC – II Classification), Ankle – Brachial Index (ABI) in preoperative and postoperative period, num-ber of stents deployed and runoff (preoperative angiography). We identified failure of the proce-dure considering clinical worsening, ABI and dupplex techniques during follow up. Kaplan-Meier curves and multivariate survival analysis were applied on variables analyzed. Results. The mean time of follow up was 22,7 months, ranging between 1 and 84 months after SFA stenting. Mean period free of reintervention or thrombosis was 8,2 months, ranging between 1 day and 52 months after stenting. Limb salvage rate was up to 46,6%, in clinical state III and IV groups. Amputation rate was 5,67% of total patients. Although 50% of these patients had a clinical state III or IV, global patency rates reached up to 46,6% in these groups. A statistically significant difference on the outcome of stenting was found in the increased postoperative ankle-brachial index (p<0,01), runoff (p = 0,03) and number of stents (p<0,01). Conclusions. Failure of stenting in AFS was not associated with significant clinical deterioration, despite most patients with failure of primary endovascular treatment required secondary surgical procedures. The low incidence of thrombosis and reduced amputation rate suggest that these pro-cedures are effective with acceptable patency rates and limb salvage.