Angiographic Dissection Patterns and Patency Outcomes After Balloon Angioplasty for Superficial Femoral Artery Disease

2017 ◽  
Vol 24 (3) ◽  
pp. 367-375 ◽  
Author(s):  
Masahiko Fujihara ◽  
Mitsuyoshi Takahara ◽  
Shinya Sasaki ◽  
Kiyonori Nanto ◽  
Makoto Utsunomiya ◽  
...  
Keyword(s):  
Predictive Factors ◽  
Femoral Artery ◽  
Balloon Angioplasty ◽  
Superficial Femoral Artery ◽  
Stent Implantation ◽  
Significant Risk ◽  
Vessel Diameter ◽  
Lesion Length ◽  
Type C ◽  
Vessel Dissection

Purpose: To investigate the angiographic dissection patterns after balloon angioplasty for superficial femoral artery (SFA) lesions, the clinical outcome associated with each dissection pattern, and the predictive factors for severe dissection. Methods: A retrospective, multicenter analysis examined 621 patients (mean age 72.8±9.5 years; 414 men) with 748 symptomatic de novo SFA lesions treated with endovascular therapy. Vessel dissection after the initial balloon angioplasty procedure was graded into 7 types according to a modified version of the coronary artery classification types A to F. Severe vessel dissection patterns were defined as type C or higher. Nitinol stent implantation was performed in 555 (74.2%) lesions for residual stenosis >30% or flow-limiting dissection; 193 lesions (25.8%) were treated with balloon angioplasty only. To determine the clinical outcomes associated with each dissection pattern and identify predictive factors for severe dissection, 2-year follow-up data for the 193 lesions treated with balloon angioplasty only were analyzed for primary patency and clinically driven target lesion revascularization (TLR). Results: No dissection was found in 16% (120/748) of lesions, and types A and B dissections were seen in 19% (142/748) and 23% (172/748), respectively. Dissection grades above type C were observed in 42% of cases, most frequently type D (180/748, 24%) and less often type C (37/748, 5%), type E (67/748, 9%), and type F (30/748, 4%). The bailout stent implantation rate increased according to dissection severity. At up to 2 years, the severe dissection group (types C–F) showed a significantly lower patency rate (p<0.001) and higher clinically driven TLR (p<0.001) compared to the nonsevere group (no dissection and types A and B dissections). Severe dissection was a significant risk factor for restenosis, which rose progressively from types C to F. Multivariate analysis identified a small reference vessel diameter <5 mm (p=0.001), lesion length >15 cm (p=0.001), and chronic total occlusion (p<0.001) as independent predictors of severe dissection. In subgroup analysis, vessels with a small reference diameter and TASC II C and D lesions had a higher prevalence of severe dissection. Conclusion: Severe dissection was found in 42% of cases after PTA. A small vessel diameter and/or TASC II C/D lesions were related to a high incidence of dissection. Severe dissection during procedures employing balloon angioplasty only could affect long-term patency.

Quality of Life after Balloon Angioplasty versus Stent Implantation in the Superficial Femoral Artery: Findings from a Randomized Controlled Trial

2007 ◽  
Vol 14 (4) ◽  
pp. 431-437 ◽  
Author(s):  
Schila Sabeti ◽  
Alfa Czerwenka-Wenkstetten ◽  
Petra Dick ◽  
Oliver Schlager ◽  
Jasmin Amighi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Femoral Artery ◽  
Balloon Angioplasty ◽  
Superficial Femoral Artery ◽  
Stent Implantation ◽  
Controlled Trial ◽  
Limb Ischemia ◽  
Post Intervention ◽  
Primary Stenting

Purpose: To investigate whether primary nitinol stenting in the superficial femoral artery (SFA) is beneficial to patients' quality of life (QoL). Methods: One hundred four patients (55 men; mean age 66±19 years) with chronic limb ischemia and SFA disease were randomly assigned to primary stent implantation (n=51) or balloon angioplasty (n=53) with optional stenting for a suboptimal angioplasty result (17 of 53). QoL was measured by the SF-36 questionnaire at baseline and at 3, 6, and 12 months post intervention. Results: QoL was significantly improved post intervention and up to 12 months in both treatment groups. Significant inverse associations were observed between QoL parameters and restenosis. Comparing primary stenting (n=51) versus balloon angioplasty with optional stenting (n=53) by the intention to treat, no significant differences in QoL were observed. Analyses of stented patients (n=68) versus balloon angioplasty (n=36) patients, however, demonstrated significantly improved measures of QoL after stenting. Conclusion: Endovascular revascularization of SFA disease improves QoL, and restenosis negatively affects QoL outcomes. After stent implantation, whether primary or secondary, QoL was significantly ameliorated compared to balloon angioplasty alone. However, it remains to be proven in larger cohorts whether primary stenting yields a QoL benefit compared to balloon angioplasty with optional secondary stenting.

scholarly journals Nitinol Stent Implantation Versus Balloon Angioplasty for Lesions in the Superficial Femoral Artery and Proximal Popliteal Artery

2010 ◽  
Vol 3 (3) ◽  
pp. 267-276 ◽  
Author(s):  
John R. Laird ◽  
Barry T. Katzen ◽  
Dierk Scheinert ◽  
Johannes Lammer ◽  
Jeffrey Carpenter ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Balloon Angioplasty ◽  
Superficial Femoral Artery ◽  
Popliteal Artery ◽  
Stent Implantation ◽  
Nitinol Stent

Lumen Loss at 1 Year After Bare Nitinol Stent Implantation in the Superficial Femoral Artery

2020 ◽  
pp. 152660282095026
Author(s):  
Nobuhiro Ito ◽  
Mitsuyoshi Takahara ◽  
Yoshimitsu Soga ◽  
Seiichi Hiramori ◽  
Kaoru Hirose ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Failure Time ◽  
De Novo ◽  
Vessel Diameter ◽  
Accelerated Failure Time Model ◽  
Lesion Length ◽  
Time Model ◽  
Nitinol Stent ◽  
The Mean

Purpose To investigate lumen loss (LL) at 1 year after bare nitinol stent (BNS) implantation for de novo superficial femoral artery (SFA) lesions. Materials and Methods The subjects were 701 consecutive patients (mean age 74±9 years; 492 men) with 817 de novo SFA lesions treated with BNS implantation between January 2004 and September 2015. The mean lesion length was 141±88 mm and the mean vessel diameter was 5.4±0.9 mm. The endpoint was LL at 1 year after BNS implantation. Secondary outcomes were restenosis and target lesion revascularization (TLR) estimated using the Kaplan-Meier method; estimates are reported with the 95% confidence interval (CI). LL was defined as the minimum lumen diameter immediately after BNS implantation minus that at 1 year measured by angiographic quantitative vessel analysis. The distribution of LL in the overall population was estimated using an accelerated failure time model. Results Mean LL at 1 year was estimated to be 1.74±1.28 mm (95% CI 1.63 to 1.84). Current smoking was positively associated with LL (p=0.015), whereas lack of cilostazol use was correlated with an increase in LL (p=0.001). Reference vessel diameter and lesion length did not have any significant association with LL at 1 year. The 1-year cumulative estimate of restenosis was 25% (95% CI 22% to 28%); the corresponding value for TLR was 18% (95% CI 15% to 21%). Conclusion Mean LL progressed by at least 1.6 mm at 1 year after BNS implantation. The risk factors for increased LL were current smoker and lack of cilostazol use.

Abstract 1788: Clinical Impact of the Diameter of a Self-expandable Stent in the Superficial Femoral Artery

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Yoshimitsu Soga ◽  
Hiroyoshi Yokoi ◽  
Tomoko Urakawa ◽  
Kenji Ando ◽  
Shinichi Shirai ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Chronic Total Occlusion ◽  
Vessel Diameter ◽  
Primary Patency ◽  
Lesion Length ◽  
Total Occlusion ◽  
Kaplan Meier ◽  
The Mean ◽  
Stent Diameter

Background Factors associated with patency of self-expandable stents placed in the superficial femoral artery (SFA) have not been clarified. In this study, we investigated the impact of stent diameter in patients who implanted self-expandable stents in the SFA. Methods Self-expandable stents were placed in SFA lesions in 80 patients (84 limbs) at our hospital between January 2003 and December 2005 and we investigated prospectively for 18 months. A total of 144 stents were used: The mean vascular diameter at sites proximal and distal to the stent-placement region on angiography was defined as the vessel diameter, and the stent diameter/vessel diameter (S/V) ratio was calculated. Results The age of the patients ranged from 44 to 88 years old (mean: 70.3 ± 6.8 years old), and 68 patients were male (85%). The mean diameter of the treated vessels was 5.1 ± 0.7 mm, the mean lesion length was 93.8 ± 43.8 mm, and 1.7 ± 0.6 stents were used per lesion. Chronic total occlusion was noted in 24 cases (30%). The primary (secondary) patency rates at 6, 12, and 18 months were 91.2% (97.5%), 74.5% (87.2%), and 63.6% (79.1%), respectively as estimated by the Kaplan-Meier method. An S/V ratio >1.3 was noted in 16 of the 80 patients (20%). There was a high percentage of patients with renal dysfunction and a smoking habit in this group, and the length of the treated lesion was long. In contrast, there were fewer patients with a high cholesterol level in this group. Other baseline parameters were similar between the two groups. A Kaplan-Meier estimate showed that the restenosis rate after 18 months was significantly higher in the S/V >1.3 group (87.5% vs. 35.5%, p<0.0001), whereas the primary patency was lower (31.3% vs. 73.4%, p<0.0001). Multivariate analysis indicated that lesion length >100 mm (Hazard ratio (HR) 6.6, p=0.015), chronic total occlusion (HR 6.0, p=0.035), stent fracture(HR 17.5, p=0.022), and S/V >1.3(HR 29.0, p=0.0014) were independent predictors of primary patency at 18 months. conclusion The stent diameter of self-expandable stent was strongest predictor in primary patency at 18 months. The stent diameter of self-expandable stent can affect patency in the chronic phase.

scholarly journals Impact of chronic outward force on arterial responses of proximal and distal of long superficial femoral artery stent

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hu Li ◽  
Seung-Woon Rha ◽  
Byoung Geol Choi ◽  
Se Yeon Choi ◽  
Sang Ki Moon ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Distal Segment ◽  
Vessel Diameter ◽  
Distal Portion ◽  
Control Group ◽  
Stent Restenosis ◽  
Histopathologic Analysis ◽  
Stent Diameter ◽  
The Impact

Abstract Background Self-expanding nitinol stent (SENS) implantation is commonly oversized in the superficial femoral artery (SFA), and leads to chronic outward force (COF) and in-stent restenosis (ISR). This study aimed to investigate the impact of COF of oversizing SENS on ISR of SFA. Methods In patients with implanted SENS in SFA, intimal hyperplasia especially between proximal segment and distal segment was evaluated by quantitative angiography, and the impact of COF on mid-term angiographic outcomes was investigated. In addition, porcine model with implanted SENS was used to evaluate the impact of COF on angiographic and histopathologic outcomes at 1 month. Excised stented arteries were evaluated by histopathologic analysis. Results We analyzed 65 SENS in 61 patients with follow-up angiography at 6 months to 1 year. The baseline diameter was 6.8 ± 0.71 mm and length were 97.0 ± 33.8 mm for the SENS. The ratio of the diameter of the stent to the reference vessel was 1.3 ± 0.24 at the proximal portion and 1.53 ± 0.27 at the distal portion (P < 0.001). In the long SFA stent, stent-to-vessel ratio was significantly higher in the distal stent than in the proximal stent (1.3 ± 0.2 vs. 1.55 ± 0.25, P = 0.001). ISR incidence was higher at the distal stent (37.3% vs 52.6%, P = 0.029). All 11 pigs survived for 4 weeks after SENS implantation. The vessel diameter was 4.04 ± 0.40 mm (control group) vs 4.45 ± 0.63 mm (oversized group), and the implanted stent diameter was 5.27 ± 0.46 mm vs. 7.18 ± 0.4 mm (P = 0.001). The stent-to-vessel diameter ratio was 1.31 ± 0.12 versus 1.63 ± 0.20 (P < 0.001). After 4 weeks, restenosis % was 29.5 ± 12.9% versus 46.8 ± 21.5% (P = 0.016). The neointimal area was 5.37 ± 1.15 mm2 vs. 8.53 ± 5.18 mm2 (P = 0.05). The restenosis % was 39.34 ± 8.53% versus 63.97 ± 17.1% (P = 0.001). Conclusions COF is an important cause of restenosis in the distal portion of the SFA stent. Optimal sizing of the SFA stent is important to reduce the incidence of restenosis. Therefore, COF was an important factor of restenosis following distal SFA stenting.

Scoring Balloon Reduces the Severity of Dissection and Stent Implantation Rate in Superficial Femoral Artery Angioplasty Compared to Plain Balloon

2020 ◽  
pp. 153857442096897
Author(s):  
Hanbee Hong ◽  
Ui Jun Park ◽  
Young Nam Roh ◽  
Hyoung Tae Kim
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Stent Implantation ◽  
Implantation Rate ◽  
Target Lesion ◽  
Drug Eluting Stent ◽  
Total Occlusion ◽  
Scoring Balloon ◽  
Significant Difference ◽  
The Difference

Purpose: The knowledge regarding the benefits of the scoring balloon (SB) in comparison to the plain balloon (PB) is limited. This study aims to elucidate the difference in efficacy between SB and PB as pre-balloon in superficial femoral artery angioplasty. Methods: We retrospectively analyzed angiographic images of 113 lesions in 98 patients treated with endovascular surgery. 37 lesions were prepared by SB and 76 lesions by PB. Lesions without significant residual stenosis nor a flow-limiting dissection were treated by drug-coated balloon and the others by drug-eluting stent. Severity of dissection was evaluated by Kobayashi dissection grade and NHLBI classification. The rate of stent implantation was compared between the 2 groups. Kaplan-Meier analysis estimated freedom from target lesion revascularization (TLR) rate at 12 months. Results: Severe dissections (>1/3 of lumen) occurred less frequently in the SB group (SB 40.5% vs. PB 75.0%, P = 0.001). Overall stent implantation rate was lower in the SB group (SB 27.0% vs. PB 55.3%, P = 0.005). In subgroup analysis for the complex lesions, the SB group had lower rate of severe dissection(>1/3 of lumen) in patients with long lesions(>15 cm) (SB 51.7% vs. PB 76.9%, P = 0.020) and lesions of calcium grade ≥2 (SB 43.8% vs. PB 72.5%, P = 0.009). SB group had lower stent implantation rate in patients with long lesions (SB 34.5% vs. PB 59.6%, P = 0.030), lesions of calcium grade ≥2 (SB 31.3% vs. PB 56.9%, P = 0.023), and total occlusion (SB 30.8% vs. PB 80.0%, P = 0.002). There were no procedure-related complications in either group except 1 case of puncture-site hematoma. There was no significant difference in TLR rate between both groups at 12 months (P = 0.509). Conclusion: SB reduces the incidence of severe dissection (>1/3 of lumen) and rate of overall stent implantation in comparison with PB. The use of SB is a safe and effective method of lesion preparation in SFA angioplasty.

scholarly journals Healing of femoral artery dissection after drug-coated balloon angioplasty: A case report with intravascular ultrasonography and angioscopy images

2019 ◽  
Vol 7 ◽  
pp. 2050313X1983415
Author(s):  
Taketsugu Tsuchiya ◽  
Minako Oda ◽  
Takaaki Takamura ◽  
Katsuhide Kitagawa ◽  
Koji Kajinami ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Balloon Angioplasty ◽  
Iliac Artery ◽  
Superficial Femoral Artery ◽  
External Iliac Artery ◽  
Artery Dissection ◽  
Intravascular Ultrasonography ◽  
Stent Deployment ◽  
Atherosclerotic Stenosis ◽  
Drug Coated Balloon

Early 80s male with intermitted claudication underwent endovascular therapy for atherosclerotic stenosis at left external iliac artery and middle of superficial femoral artery. Patient also had chronic atrial fibrillation, diabetes mellitus, and hypertension. After stent deployment for external iliac artery lesion, a short superficial femoral artery lesion was performed with angioplasty using drug-coated balloon. The drug-coated balloon angioplasty resulted in 50% residual stenosis with linear dissection; however, provisional stenting was not performed as decent ante-grade blood flow allowed 10 extra minutes. Medication involved ongoing use of aspirin 100 mg and rivaroxaban 15 mg. Angiography post 3 months from index procedure showed external iliac artery and superficial femoral artery patency and healing of intimal dissection at superficial femoral artery lesion was estimated by intravascular ultrasonography. In angioscopy findings, red thrombus was seen in dissection cavity.

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