Document Detail


Below knee bare nitinol stent placement in high-risk patients with critical limb ischemia is still durable after 24 months of follow-up.
MedLine Citation:
PMID:  20541349     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: This study evaluated the durability of nitinol stent placement in high-risk patients with chronic critical limb ischemia (CLI) and infrapopliteal lesions after suboptimal balloon angioplasty.
METHODS: Between January 2006 and January 2009, 53 high-risk patients (24 women; mean age, 71.8 +/- 5.1 years) with CLI underwent infragenicular stent placement with a 4F sheath-compatible self-expanding nitinol stent. Patients had three or more serious cardiopulmonary comorbidities, including chronic obstructive pulmonary disease, congestive heart failure, coronary artery occlusive disease, American Society of Anesthesiologists score >/=3, previous myocardial infarction, coronary stent or bypass, or infection after peripheral revascularization. Endovascular therapy was performed in 30 stenoses and 23 occlusions in 53 patients. The mean stenosis length was 5.5 +/- 1.9 cm. The mean occlusion length was 6.5 +/- 2.9 cm. The mean follow-up was 24.1 +/- 7.3 months and consisted of clinical examination, ankle-brachial index (ABI) measurements, and duplex ultrasound imaging. Digital subtraction angiography was performed if restenosis or reocclusion was suspected.
RESULTS: The technical success rate was 98.1%. The 24-month cumulative primary patency rate was 75.5%. During the follow-up, two patients underwent successful repeat angioplasty, and four patients required crural bypass. The 24-month secondary patency and freedom from amputation rates were 88.7% and 88.7%, respectively. The mean ABI increased significantly at 12 and 24 months (P < .001). Risk stratification to detect predictors that influenced the patency rate showed that proximal lesions had significant better patency than distal crural lesions (83.3% vs 65.2%, P = .04). The morphology of the lesions (stenoses vs occlusions, P = .88) did not seem to influence primary patency. Four patients died from nonprocedure-related causes during the follow-up, including lung cancer, myocardial infarction, and glioblastoma multiforme. No procedure-related deaths were recorded.
CONCLUSIONS: The 2-year outcome of our series underscores the value of infrapopliteal nitinol stent placement as a durable bailout treatment option in high-risk CLI patients with suboptimal angioplasty.
Authors:
Konstantinos P Donas; Giovanni Torsello; Arne Schwindt; Eva Schönefeld; Olga Boldt; Georgios A Pitoulias
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2010-06-11
Journal Detail:
Title:  Journal of vascular surgery     Volume:  52     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-30     Completed Date:  2010-08-31     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  356-61     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany. k.donas@gmx.at
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MeSH Terms
Descriptor/Qualifier:
Aged
Alloys*
Amputation
Angiography, Digital Subtraction
Angioplasty, Balloon / adverse effects,  instrumentation*
Ankle Brachial Index
Constriction, Pathologic
Critical Illness
Female
Humans
Ischemia / diagnosis,  etiology,  physiopathology,  therapy*
Kaplan-Meier Estimate
Limb Salvage
Lower Extremity / blood supply*
Male
Peripheral Vascular Diseases / complications,  diagnosis,  physiopathology,  therapy*
Prosthesis Design
Recurrence
Retrospective Studies
Risk Assessment
Risk Factors
Stents*
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Duplex
Vascular Patency
Vascular Surgical Procedures
Chemical
Reg. No./Substance:
0/Alloys; 52013-44-2/nitinol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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