Infrarenal aortic stenosis: Value of stent placement after percutaneous transluminal angioplasty failure

PURPOSE: To evaluate the long-term clinical and hemodynamic effectiveness o f aortic stent placement in cases of failure of intended infrarenal percuta neous transluminal aortic angioplasty (PTAA). MATERIALS AND METHODS: Fifty-three patients who underwent technically succe ssful PTAA were compared with 24 patients who underwent aortic stent placem ent because of PTAA failure (19 patients) or ulcerated lesions (five patien ts) that otherwise would have been treated surgically because of the emboli zation hazard associated with PTAA alone. Clinical patency was defined as t he absence or improvement of symptoms after the intervention. Hemodynamic p atency was defined as a normal Doppler waveform in the common femoral arter ies, an ankle-brachial index greater than 0.95, or the absence of a thigh-b rachial pressure gradient. RESULTS: Three-year clinical and hemodynamic patency rates, respectively, w ere 85% and 79% for PTAA and 69% and 43% for aortic stent placement. No mor bidity was encountered. With use of the Cox proportional hazards model, two significant risk factors were retained for restenosis: unchanged smoking h abit (P = .04) and small dilatation diameter (P = .001). Aortic stent place ment, performed in patients with a smaller aortic diameter (10.3 vs 12.7 mm for PTAA), appeared to be a predictive factor for restenosis by using univ ariate analysis. By using the Cox proportional hazards model, however, the restenosis rates after PTAA and aortic stent placement were not significant ly different. CONCLUSION: When aortic diameter is taken into consideration, there is no e vidence that clinical outcome after secondary aortic stent placement would be poorer than technically successful PTAA.