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Long-term patency for covered stents acceptable in SFA occlusive disease
New data suggest that the 5-year patency for self-expanding covered stents used for the treatment of superficial femoral artery occlusive disease was within an acceptable range, with the larger diameter stent performing better than the smaller iterations.
The dual-center study included 315 consecutive patients (mean age, 69 years; 73.7% men) who had superficial femoral artery (SFA) occlusive disease in 334 limbs. Patients were treated with a self-expanding covered stent (Viabahn, W.L. Gore & Associates) from 2001 to 2014 and were retrospectively evaluated.
Researchers defined primary patency as the absence of restenosis or occlusion of the treated segment achieved without reintervention, whereas patency after surgical or endovascular intervention for covered stent occlusion was considered secondary patency.
According to patient characteristic data, mean lesion length was 11.7 ± 8.8 cm, and half of the lesions were categorized as TransAtlantic Inter-Society Consensus (TASC) II C/D.
At 5 years, all-cause mortality was 14.1%.
Rates of primary patency were 72.2% at 1 year, 51.8% at 3 years and 47.6% at 5 years. Secondary primary patency rates were 86.2% at 1 year, 78.7% at 3 years and 77.5% at 5 years.
In univariate analysis, predictors of the loss of primary patency included covered stent diameter (P = .001), number of covered stents per lesion (P = .015) and TASC II D classification (P = .007). However, in multivariate regression analysis, only covered stent diameter predicted loss of primary patency (P = .001), with the 7-mm covered stents outperforming the 5-mm and 6-mm sizes.
“Covered stent diameter is the most relevant factor in predicting loss of primary patency, and thus, an adequate diameter of the distal landing site seems to be among the most important factors in the decision-making process,” the researchers wrote. “In smaller vessels, one should not use covered stents but venous conduits, as oversizing may be detrimental.” – by Brian Ellis
Disclosure: Three researchers report receiving speakers’ fees and/or research funding from W.L. Gore & Associates. The other researchers report no relevant financial disclosures.