HIGH-INCIDENCE OF RESTENOSIS REOCCLUSION OF STENTS IN THE PERCUTANEOUS TREATMENT OF LONG-SEGMENT SUPERFICIAL FEMORAL-ARTERY DISEASE AFTER SUBOPTIMAL ANGIOPLASTY/

Purpose: To evaluate the efficacy of intravascular stents used to trea t long-segment stenoses and occlusions of the superficial femoral arte ry (SFA) after suboptimal angioplasty. Methods: Fifty-eight limbs in 5 5 patients who underwent stenting of the SPA were identified from a va scular registry. Indications for stent placement after suboptimal PTA included flow-limiting dissection, residual pressure gradient (>15 mm Hg) or stenosis (>30%), or failure to establish initial patency. Lesio n length ranged from 6 to 35 cm (mean, 16.5 cm). Endpoints for primary patency were: restenosis of >50%, reocclusion, or diminution of the p ostprocedure ankle-brachial index greater than 0.15. Results: The mean ankle-brachial index improved from 0.48+/-0.19 to 0.71+/-0.23 (p=0.00 1). Primary patency rates by Kaplan-Meier estimates at 1 month, 6 mont hs, and 1 year were 88%, 47%, and 22%, respectively. Secondary patency rates were 94% at 1 month, 59% at 6 months, and 46% at 1 year. The me dian time to reaching an endpoint of restenosis or reocclusion was 6 m onths primarily and 9 months secondarily. Clinical improvement at the time of latest follow-up occurred in 56% of patients (mean, 13.8 month s). Periprocedural complications occurred in 24.5% of patients with th e first intervention. The only factor that favorably influenced outcom e was improvement in clinical category after the procedure (P=0.001). Conclusions: There was a high incidence of restenosis and reocclusion with long-segment SPA disease that required stents to achieve initial success. Despite close surveillance and reintervention, anatomic paten cy at 1 year was poor. However, clinical benefit was maintained in the majority of patients. The outcome was similar in the claudication pop ulation compared with those who had limb-threatening ischemia. Percuta neous revascularization of long-segment SFA disease requiring stents s hould be reserved for patients with critical limb ischemia for which n o reasonable surgical alternative exists.