Document Detail


Patterns of femoropopliteal recurrence after routine and selective stenting endoluminal therapy.
MedLine Citation:
PMID:  22975333     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: This study determined the incidence and characteristics of recurrent disease after femoropopliteal angioplasty, following either selective or routine stenting of diseased site(s).
METHODS: Retrospective analysis of a prospectively maintained database for femoropopliteal interventions from June 2003 to July 2010 was performed. Interventions during this period were from a single institution, followed up at 1, 3, and 6 months after initial intervention and on a semiannual basis thereafter with clinical examinations and duplex ultrasound imaging. Two groups were identified: those with routine stenting (RS; routine stenting for all diseased areas) and those with selective stenting (SS; selective stenting for only segments which exhibited compromised flow from residual stenosis or significant dissection). Patients who developed recurrent symptoms (claudication, rest pain), a decrease in ankle-brachial index (ABI) (>0.2), or duplex documentation of a significant (>80%) recurrent stenosis underwent reintervention. Patient demographics, comorbidities, Trans-Atlantic Inter-Society Consensus (TASC) II classification, runoff, and degree of calcification (none, mild, moderate, severe) at initial intervention were recorded. The time to reintervention and recurrence pattern were recorded for both groups.
RESULTS: During the study period, 746 endovascular interventions in 477 patients were performed. Total reintervention rate, including bypass, amputation, and asymptomatic occlusion after initial intervention, was 36.48% (group SS, 42.9%; group RS, 33.1%; P=.04). Of all initial interventions, 182 endovascular reinterventions in 165 patients for recurrent femoropopliteal disease were identified (group SS, 70; group RS, 95). No differences were noted among the groups in gender, comorbidities, initial TASC II classification, run off, calcification scores, or statin or clopidogrel use, or both. Time to recurrence was similar in the RS and SS groups. TASC II classification, runoff score, and degree of calcification were similar between the two groups. Although not statistically significant, analysis of recurrence pattern demonstrated de novo stenosis was more common in the SS group (50.0% vs 34.7%; P=.06).
CONCLUSIONS: This single-center retrospective study found a significant difference in the incidence of recurrence requiring reintervention between patients treated with selective and routine stenting for femoropopliteal disease. Analysis of endovascular reinterventions, however, reveals no significant difference in recurrence time or recurrence pattern between the two groups. No significant differences were identified in time to recurrence, TASC II classification, runoff, and calcification of endovascular reinterventions between the two groups' end points. Additional prospective studies to evaluate the roles of routine and selective stenting in symptomatic femoropopliteal peripheral arterial disease and to investigate recurrence lesion characteristics and the patency of multiple endovascular interventions between these two groups are needed.
Authors:
Misaki M Kiguchi; Luke K Marone; Rabih A Chaer; Daniel G Winger; Zhen Yu Shi; Rolando I Celis; Michel S Makaroun; Robert Y Rhee
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2012-09-10
Journal Detail:
Title:  Journal of vascular surgery     Volume:  57     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-24     Completed Date:  2013-02-20     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  37-43     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Amputation
Angioplasty, Balloon / adverse effects,  instrumentation*
Constriction, Pathologic
Female
Femoral Artery* / radiography,  ultrasonography
Humans
Incidence
Limb Salvage
Male
Middle Aged
Pennsylvania / epidemiology
Peripheral Arterial Disease / diagnosis,  epidemiology,  surgery,  therapy*
Popliteal Artery* / radiography,  ultrasonography
Recurrence
Retrospective Studies
Stents*
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Duplex
Vascular Grafting
Grant Support
ID/Acronym/Agency:
T32 HL098036/HL/NHLBI NIH HHS; UL1-RR-024153/RR/NCRR NIH HHS; UL1-TR-000005/TR/NCATS NIH HHS

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