Failed superficial femoral artery intervention for advanced infrainguinal occlusive disease has a significant negative impact on limb salvage. Journal Article

Authors: Al-Nouri, O.; Krezalek, M.; Hershberger, R.; Halandras, P; Gassman, A.; Aulivola, B; Milner, R.
Article Title: Failed superficial femoral artery intervention for advanced infrainguinal occlusive disease has a significant negative impact on limb salvage.
Abstract: OBJECTIVE: Endovascular treatment of superficial femoral artery (SFA) lesions is a well-established practice. The repercussions of failed SFA interventions are unclear. Our goal was to review the efficacy of SFA stenting and define negative effects of its failure. METHODS: A retrospective chart review was conducted from January 2007 to January 2010 that identified 42 limbs in 39 patients that underwent SFA stenting. Follow-up ankle-brachial index and a duplex ultrasound scan was performed at routine intervals. RESULTS: Mean patient age was 68 years (range, 43-88 years); there were 22 men (56%) and 17 women (44%). Intervention indication was claudication in 15 patients (36%), rest pain in seven patients (17%), and tissue loss in 19 patients (45%). There were 15 patients (36%) with TransAtlantic Inter-Society Consensus (TASC) A, nine patients (21%) with TASC B, five patients (12%) with TASC C, and 13 patients (31%) with TASC D lesions. The majority of lesions intervened on were the first attempt at revascularization. Three stents (7.7%) occluded within 30 days. One-year primary, primary-assisted, and secondary patency rates were 24%, 44%, and 51%, respectively. Limb salvage was 93% during follow-up. Seventeen interventions failed (40%) at 1 year. Of these, seven patients (41%) developed claudication, seven patients (41%) developed ischemic rest pain, and three patients (18%) were asymptomatic. During follow-up, three patients (7.7%) required bypass and three patients (7.7%) major amputation, one after failed bypass. All limbs requiring bypass or amputation had TASC C/D lesions. Thirty-day and 1-year mortality was 2.6% and 10.3%, respectively. CONCLUSIONS: Interventions performed for TASC C/D lesions are more likely to fail and more likely to lead to bypass or amputation. Interventions performed for TASC C/D lesions that fail have a negative impact on limb salvage. This should be considered when performing stenting of advanced SFA lesions. Copyright Copyright 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Journal Title: Journal of vascular surgery
Volume: 56
Issue: 1
ISSN: 1097-6809; 0741-5214
Publisher: Mosby, Inc  
Journal Place: United States
Date Published: 2012
Start Page: 106
End Page: 110
Language: English
Notes: ID: 12521; Record Owner: From MEDLINE, a database of the U.S. National Library of Medicine.; Status: MEDLINE; Comments: Comment in: J Vasc Surg. 2012 Jul;56(1):111-2; PMID: 22749265; Publishing Model: Journal available in: Print-Electronic Citation processed from: Internet; NLM Journal Code: kd2, 8407742; Electronic Date of Publication: 20120105; Entry Date: 20120920