Related Experiment Videos
Long-term outcomes following primary drug-eluting stenting of infrapopliteal bifurcations
Stavros Spiliopoulos1, George Fragkos, Konstantinos Katsanos
1Department of Diagnostic and Interventional Radiology, Patras University Hospital, School of Medicine, Rion, Greece. stavspiliop@upatras.gr
Insights
Drug-eluting stents (DES) show safe and effective outcomes for critical limb ischemia (CLI) patients with infrapopliteal bifurcation lesions. Long-term results demonstrate good amputation-free survival and target lesion revascularization rates.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Therapy
Background:
- Critical limb ischemia (CLI) poses a significant challenge in vascular medicine.
- Infrapopliteal artery disease, particularly involving bifurcations, requires effective treatment strategies.
- Drug-eluting stents (DES) offer a potential solution for complex below-the-knee lesions.
Purpose of the Study:
- To evaluate the clinical and angiographic outcomes of primary drug-eluting stent (DES) deployment.
- To assess the safety and efficacy of DES in treating infrapopliteal bifurcation lesions in CLI patients.
- To analyze amputation-free survival, target lesion revascularization (TLR)-free survival, and primary patency rates.
Main Methods:
- Retrospective analysis of a registry of patients with chronic infrapopliteal artery disease.
- Inclusion of 39 CLI patients undergoing treatment of 41 infrapopliteal bifurcations using DES.
- Comparison of single stent, T-shape double-stent, and culotte double-stent techniques.
Main Results:
- High technical success rate for DES deployment.
- Five-year estimates for overall survival, amputation-free survival, and TLR-free survival were 79.5%, 84.3%, and 58.0%, respectively.
- Long-term primary patency rates (1-vessel and 2-vessel) demonstrated sustained limb salvage, despite significant binary restenosis rates.
Conclusions:
- Primary DES application for below-the-knee bifurcation lesions is a safe procedure.
- Satisfactory long-term angiographic and clinical outcomes were achieved.
- Results are comparable to existing infrapopliteal endovascular treatments.
Purpose:
To investigate the outcomes following primary deployment of drug-eluting stents (DES) for the treatment of infrapopliteal bifurcation lesions in patients suffering from critical limb ischemia (CLI).
Methods:
This was a retrospective study of a registry enrolling all patients suffering from chronic infrapopliteal artery disease and undergoing treatment of tibial bifurcation lesions with DES using 3 techniques: balloon and stent (single stent), T-shape double-stent, and culotte double-stent. The analysis included 39 CLI patients (32 men; mean age 69 ± 10 years) who underwent primary stenting of 41 infrapopliteal bifurcations. Most patients (29, 70.7%) were classified as Rutherford category 4. The mean lesion length was 31.3 ± 13.1 mm. The primary endpoints were amputation-free survival, target lesion revascularization (TLR)-free survival, angiographic 2-vessel primary patency (2VPP), and 1-vessel primary patency (1VPP). Secondary endpoints included survival and angiographic binary restenosis. A Cox regression analysis was performed to identify independent predictors influencing outcomes
Results:
Technical success was achieved in all cases. The mean clinical and angiographic follow-up intervals were 47.5 ± 14.8 and 17.5 ± 12.5 months, respectively. According to the Kaplan-Meier analysis, overall survival, amputation-free survival, and TLR-free survival estimates were 79.5%, 84.3%, and 58.0%, respectively, at 5 years. At 12, 24, and 36 months, the 2VPP rates were 77.2%, 47.5%, and 33.9%, and the 1VPP rates were 84.0%, 65.5%, and 54.5%, respectively. Binary restenosis rates were 26.4%, 57.3%, and 82.2% at 12, 24, and 36 months; restenotic lesions were mainly detected at the origin of the bifurcations. The regression model did not identify any independent predictors influencing outcome.
Conclusion:
DES application for below-the-knee bifurcation lesions was safe and resulted in satisfactory long-term angiographic and clinical outcomes comparable to those reported following infrapopliteal endovascular treatment.
Related Concept Videos
01:27Peripheral Artery Disease III: Interprofessional Care
01:23Peripheral Artery Disease V: Postoperative Nursing Management