Long -Term Patency and Clinical Outcomes of Nitinol Stenting for Femoropopliteal Atherosclerotic Disease

Background: Treatment of peripheral arterial disease (PAD) has become increasingly domi- nated by endovascular interventions. The short-term outcomes of endovascular therapy have been well studied, but late outcomes remain largely unpublished; in this series, we report the late outcomes of primary nitinol stenting. Methods: All patients undergoing primary nitinol stenting of the superficial femoral artery (SFA) and/or popliteal artery (PA) during a 10-year period by a single surgeon (S.K.) were reviewed. No attempts were made on patients with orificial or total occlusion of the SFA, PA, and proximal tibial arteries. Differences in primary patency, primary-assisted patency, secondary patency, and freedom from bypass were evaluated at 1, 5, and 9 years. Results: A total of 294 limbs in 240 patients were treated. One hundred and thirty additional endovascular procedures were observed during the study period averaging to 0.16 endovascu- lar interventions per limb per year. Primary patency in TASC A/B limbs at 1, 5, and 9 years was 79%, 35%, and 19%, respectively, and in TASC C/D limbs was 62%, 11%, and 3%, respectively. Secondary patency in TASC A/B limbs at 1, 5, and 9 years was 96%, 81%, and 65%, respec- tively, and in TASC C/D limbs was 92%, 64%, and 41%, respectively. Freedom from bypass in TASC A/B limbs at 1, 5, and 9 years was 98%, 89%, and 85%, respectively, and in TASC C/D limbs was 95%, 78%, and 69%, respectively. Five below-the-knee amputations were observed during the study period. Conclusions: An endovascular-first approach can be applied to the vast majority of femoropo- pliteal lesions. While the late outcomes of TASC C/D lesions are inferior to those of TASC A/B lesions, an endovascular-first approach still provides durable outcomes.