Angioplasty and stent placement in chronic occlusion of the superficial femoral artery: Technique and results

PURPOSE: To improve the patency rate for angioplasty in chronic occlusion o f the superficial femoral artery by deploying stents after angioplasty. MATERIALS AND METHODS: Angioplasty and stent placement were performed in 61 arteries in 48 male patients. The mean occlusion length was 13.5 cm and th e mean stent length was 30 cm. Patency rates were analyzed at 6 months and at 1, 2, 3, and 4 years. The predictors of restenosis were analyzed by univ ariate and multiple logistic regression. RESULTS: Patency rates were 87% at 6 months, consisting of 74% primary, 6% primary assisted, and 7% secondary; 79% at 1 year, consisting of 47% primar y, 19% primary assisted, and 13% secondary; 72% at 2 years, consisting of 3 6% primary, 26% primary assisted, and 10% secondary; 70% at 3 years, consis ting of 26% primary, 22% primary assisted, and 22% secondary; and 63% at 4 years, consisting of 25% primary, 0% primary assisted, and 38% secondary. T here was a 15% morbidity rate and one mortality as a result of retroperiton eal bleeding. Better patency rates were noted at all time intervals in diab etic limbs, 7-mm-diameter versus 10-mm-diameter stents, shorter obstruction s and shorter stents, nonsmokers, in limbs in which urokinase was not neces sary after stent deployment, and in limbs with an International Society of Cardiovascular Surgery (ISCVS) classification under 3. Patency rates were n ot affected by age, race, number of trifurcation vessels patent, experience in performing the procedures, and procedures requiring less time. By multi variate logistic analysis, the independent predictors of patency at 6 month s were postprocedure ankle/brachial index (ABI) and shorter stent length; a t 1 year, preprocedure ABI, shorter stent length, and the presence of diabe tes; at 2 years, preprocedure ABI and the presence of diabetes; and at 3 ye ars, the preprocedure ABI. CONCLUSIONS: The techniques used to reestablish antegrade flow in these sup erficial femoral arteries yielded a high success rate. In addition, the use of angioplasty with stents may improve patency rates over angioplasty with out stents.