Utility of stent-Grafts in the treatment of superficial femoral artery (SFA) occlusive disease

Background: To evaluate the efficacy of stent grafts in the treatment of chronic SFA occlusive disease
Methods: During a 5.2 year period, 48 patients (51 limbs; 34 men; mean age 67 years) with superficial femoral artery occlusive disease were treated with endovascular stent-graft device. Patients had chronic limb ischemia; classified by TASC score (TASC A- 17%, B- 23%, C- 39%, D- 19%)
Results: Stent-Graft deployment was successful in 50/51 limbs. In one limb deployment failed secondary to sheath breakage. This was successfully extracted and another graft placed at the same visit. Peri-procedural complications of distal embolization occurred in one incidence (2%) and were treated successfully with catheter directed thrombolysis. Hematoma/ pseudoaneurysm at puncture site occurred in one patient (2%). Early thrombosis (within 30 days) occurred in one patient who ended up with amputation of the limb. Primary patency at 30 days was 98%. At one year; primary, primary assisted and secondary patencies were 73%, 75% and 91% respectively. At 3 years; primary, primary assisted and secondary patencies were 40%, 44% and 76% respectively. Unless contraindicated all patients were anticoagulated with atleast one of the four following drugs- Aspirin, Plavix, Coumadin and Aggrenox. Patency rate was not affected by anti-coagulation regimen or length of the lesion.
Conclusions: Stent-Grafts seem to be suitable for SFA stenosis at least in the short term and may offer a reasonable alternative to bypass surgery in patients with high morbidity. In appropriately selected individuals, stent-graft patency approaches that of prosthetic femoro-popliteal bypass. Their long-term efficacy is yet to be proven