Draxler MS, Al Adas Z, Abbas D, Kavousi Y, Lin JC, Kabbani L, Shepard A, and Nypaver T. Superficial femoral artery balloon angioplasty stent implantation-outcome stratified by type of follow-up evaluation: Arterial duplex imaging versus ankle-brachial index only. J Vasc Surg 2018; 67(6):e221-e222.
J Vasc Surg
Objectives: Endovascular therapy with transluminal angioplasty with stent deployment has become a commonly performed intervention in the management of superficial femoral artery (SFA) occlusive disease. In-stent stenosis occurs in approximately 16% to 32% of patients at one-year follow-up and can lead to stent occlusion and symptom recurrence. Arterial duplex stent imaging (ADSI) of the stented segment can be diagnostic for recurrent stenosis, however, its uniform application and benefit is controversial. With this study we aim to determine whether follow-up with ADSI yielded a better outcome than those with Doppler and ankle-brachial index (ABI) follow-up alone.
Methods: We performed a retrospective analysis collecting data of patients undergoing SFA stent implantation for occlusive disease at a tertiary care referral center between 2009 and 2016. Patients with PTA only, those with an in-stent restenosis, and those with no follow-up were excluded. The remaining patients were divided into those with at least one ADSI (ADSI group) and those with clinical/ABI follow-up only (ABI group). Variables analyzed included patients demographics, comorbidities, indication and procedural details. The two groups were compared via univariate analysis with respect to the following variables: patency, proximal/distal (relative to stent) progression and intervention, major adverse limb event, limb loss and mortality.
Results: There were 238 patients with SFA stent implantation included in the study, 152 into ADSI and 86 into ABI. There was no difference in demographics and comorbidities between the groups. ADSI and ABI were homogenous regarding clinical presentation (claudication/critical limb ischemia ADSI 39.1%/60.9% vs ABI 37.6%/62.4%; P = .982) and Trans-Atlantic Inter-Society Consensus classification (P = .546). The 1-year outcome showed a similar primary patency rates for ADSI (63.8%) versus ABI (65.1%; P = .841). Both groups had improvement in assisted patency, however, ADSI had a higher assisted patency compared with ABI (81.6% vs 69.8%; P = .037). Secondary patency was also higher for ADSI (88.1%) vs ABI (72.9%; P = .003). Despite similar clinical presentations, ABI patients were more likely to undergo a major amputation (ABI 14.7% vs ADSI 3.4%; P = .002) at the 1-year follow-up.
Conclusions: In SFA stent implantation, ADSI follow-up shows an advantage in assisted patency and secondary patency, which may contribute to a decreased rate of major amputation. Within the first year of follow-up evaluation of SFA stent implantation, ADSI would seem to be advantageous and consideration should be given to more uniform application of surveillance ADSI.