Treatment of longitudinal femoropopliteal vascular lesions with stents - Case reports.

Purpose: In a retrospective analysis the results of stent implantation in t he superficial femoral and popliteal arteries were analysed. The stenoses w ere all larger than 10 cm in length. Patients and Methods: In 76 patients ( 3 women, 13 men, mean age 74 years) 15 occlusions and 2 stenoses (average l esion length 13.9 cm) in the superficial femoral and popliteal arteries wer e treated with stents. Prior to treatment, 11 patients were in clinical sta ge 2 b, 1 in stage 3, and 5 in stage 4 according to Fontaine. In 15 cases a wall stent was implanted and in 2 a wall stent combined with a nitinol ste nt since a wall stent of ideal length was not available. The patients recei ved heparin through a Venous lock during the operation and as infusion for 24 hours after the operation, as well as ticlopidine for 4 weeks and acetyl salicylic acid as long-term medication. Results: All 17 lesions were recana lised without residual stenoses. After stent implantation the arterial syst em was completely restored in 3 limbs, 8 patients were in stage 1, 2 in sta ge 2a, 2 in stage 2b, and 1 still in stage 4 according to Fontaine. 8 patie nts suffered from a stent thrombosis (within 1 week, after 3 weeks, and aft er 3 months). 4 stents were treated by angioplasty 4 and 5 months after imp lantation for suspected intimal hyperplasia. According to Kaplan-Meier the primary patency rate after 12 months was 85% (+/-12 SD), the secondary rate 76% (+/-10 SD). Conclusions: The primary treatment of longer femoropoplite al lesions with stents does not result in a satisfactory primary patency ra te. The patency rate after 1 year can be increased to 76% by strict monitor ing and reintervention. The method may be recommended, albeit with limitati ons, for patients in whom a bypass operation is not possible or not desired .