Superficial femoral artery recanalization with self-expanding nitinol stents: long-term follow-up results.

PURPOSE: Since long-term patency and device integrity of nitinol stents in SFA lesions are not well studied, we examined clinical outcome, patency and device integrity after stenting long lesions using a standardized implantation technique. METHODS: Between 2001 and 2006, 59 patients (74 lesions) were treated with the same nitinol self-expandable stent (Zilver, Cook, USA) and technique for SFA recanalization. Clinical charts and imaging were retrospectively reviewed for patency (primary and assisted-primary), and device integrity. RESULTS: Patients were 74.5 (10.9) years old (range 49 to 93), 64% male, 42% diabetic, 62% hypertensive and 67% current or former smokers. Lesions were 23% TASC B, 16% TASC C, or 61% TASC D. Mean recanalization length was 19 cm (range 3 to 53). Mean number of stents per patient was 2.8 (total 210). Mean follow-up time was 2.4 years (range 3 days to 4.8 years). Kaplan-Meier estimates for primary patency rates were 90%, 78%, 74%, 69%, and 69% at 1, 2, 3, 4 and 4.8 years, respectively. Ten restenoses at a mean of 500 (388) days (1-1251 days) were successfully recanalized. The assisted primary patency rates were 96%, 90%, 90%, 90% and 90% at 1, 2, 3, 4 and 5 years, respectively. Six complete occlusions could not be reverted by a second recanalization procedure, and were treated by surgical bypass (1 case), amputation (3 cases), or medical management (2 cases). One (1.04%) Class II stent fracture was noted. CONCLUSIONS: SFA recanalization with a standardized implantation technique and nitinol stents provides good long-term primary and assisted-primary patency.

Deliberate subclavian artery occlusion during aortic endovascular repair: is it really that safe?

PURPOSE: To report a series of cases in which deliberate occlusion of the left Subclavian Artery (SA) caused the Subclavian Steal Syndrome (SSS). METHODS: Between January 2001 and August 2006, we performed 81 endovascular repairs of the Thoracic Aorta. 21 patients required left SA occlusion for an adequate proximal landing zone. 17 of these patients were treated by deliberate SA occlusion. Four patients (23.5%) developed a SSS, of which three were treated by a secondary Subclavian-to-carotid transposition, with complete remission of the SSS. RESULTS: The subclavian-to-carotid transposition was successful in the treatment of the 3 patients selected. One patient refused to be operated, and had only partial remission of the SSS symptoms. Mean follow-up was 28 months (range 2-48). CONCLUSION: In this series deliberate occlusion of the SA led to SSS in a significant number of patients. Consideration should be given to primary subclavian transposition in some patients requiring subclavian occlusion.