Jesus Matos2, Carlos F. Bechara1, Neal R. Barshes1, Briauna Lowery1, George Pisimisis1, Sherene Sharath1, Peter H. Lin2, Panos Kougias1
1Surgery, Michael E. DeBakey VAMC, Houston, TX; 2Baylor College of Medicine, Houston, TX.
OBJECTIVES: We sought to determine the relative effectiveness of bare metal (BM) and covered stents (CS) when used in the treatment of patients with long TASC-II D SFA and popliteal lesions.
METHODS: This was a retrospective cohort analysis of consecutive patients with SFA and popliteal TASC II Type C and D lesions, who underwent endovascular intervention for claudication or critical limb ischemia with either BM or CS. Cox regression was used for time to event analysis and logistic regression for analysis of categorical outcomes. All results are reported adjusted for statistically significant covariates.
RESULTS: We studied 166 patients for an average of 18 (range 3-42) months. Treated lesions had an average length of 32cm (range: 15-52cm) and included total occlusions (n=91) and mixed stenoses and occlusions (n=75). Covered stents were more commonly placed for total occlusions (71 vs. 44%, p=0.001). The BM stents were more commonly placed in patients on statins (79 vs. 60%, p=0.014). Otherwise, the two groups were similar in age, Rutherford stage on initial presentation, runoff status and comorbidity distribution. The primary patency for the CS vs. the BM group was 61 vs. 43%, 42 vs. 27% and 34 vs. 20% at 12, 18 and 24 months, respectively (p=0.03). Secondary patency for the CS vs. the BM group was 76 vs. 73%, 62 vs.65% and 56 vs. 65% at 12, 18 and 24 months, respectively (p=0.65). Major amputations (HR: 1.85, p=0.4), open reinterventions (HR: 1.43, p=0.34) and endovascular reinterventions (HR: 1.41, p=0.43) were similar between the groups. Patients with claudication as initial indication for treatment who received BM stent were less likely to develop critical limb ischemia after stent occlusion (OR: 0.25, p=0.016).
CONCLUSIONS: Compared to BM stent use of CS in the treatment of advanced SFA and popliteal lesions is associated with higher primary patency rates. Patients are more likely to advance from claudication to critical limb ischemia after failure of a covered stent.
AUTHOR DISCLOSURES: N. R. Barshes: Nothing to disclose; C. F. Bechara: Nothing to disclose; P. Kougias: Nothing to disclose; P. H. Lin: Nothing to disclose; B. Lowery: Nothing to disclose; J. Matos: Nothing to disclose; G. Pisimisis: Nothing to disclose; S. Sharath: Nothing to disclose.
Posted April 2013