Outcome Benefit of Arterial Duplex Stent Imaging After Superficial Femoral Artery Stent Implantation

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Journal of vascular surgery


INTRODUCTION: In-stent stenosis is a frequent complication of superficial femoral artery (SFA) endovascular intervention and can lead to stent occlusion and/or symptom recurrence. Arterial duplex stent imaging can be used in the surveillance for recurrent stenosis, however, its uniform application is controversial. In this study, we aim to determine, in patients undergoing SFA stent implantation, whether surveillance with arterial duplex stent imaging yielded a better outcome than those with only ankle-brachial index (ABI) follow-up.

METHODS: We performed a retrospective analysis of all patients undergoing SFA stent implantation for occlusive disease at a tertiary care referral center between 2009 and 2016. The patients were divided into those with arterial duplex stent imaging (ADSI group) and those with ankle brachial index follow-up only (ABI group). Life table analysis was performed, comparing stent patency, major adverse limb event, limb salvage, and mortality between groups.

RESULTS: Two hundred forty-eight patients with SFA stent implantation were included: 160 into ADSI; 88 into ABI. Groups were homogenous regarding clinical indication (claudication/critical limb ischemia ADSI 39/61% vs ABI 38/62%; P = 0.982) and TASC classification (TASC A/B/C/D for ADSI 17/45/16/22% and ABI 21/43/16/20%; P = 0.874). Primary patency was similar between groups at 12/36/56 months: ADSI (65/43/32%) vs ABI (69/34/34%) (P = 0.770), whereas ADSI patients showed an improved assisted primary patency (84/68/54%) vs ABI (76/38/38%; P = 0.008) and secondary patency. There was a greater freedom from major adverse limb event in the ADSI group (91/76/64%) vs the ABI group (79/46/46%) (P < 0.001) at 12/36/56 months follow-up. Arterial duplex stent imaging patients were more likely to undergo an endovascular procedure as their initial post-SFA stent implantation intervention (P = 0.001) whereas ABI patients were more likely to undergo an amputation (P < 0.001).

CONCLUSIONS: In SFA stent implantation, patients with arterial duplex stent imaging follow-up demonstrate an advantage in assisted-primary patency and secondary patency and are more likely to undergo an endovascular re-intervention. These factors likely effected a decrease in major adverse limb events, indicating the benefit of a more universal adoption of post-SFA stent implantation follow-up arterial duplex stent imaging.

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ePub ahead of print