Outcomes of endovascular treatment of superficial femoral artery in-stent stenosis and/or occlusion

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Abstract

Introduction
In-spite the development of novel therapies for femoropopliteal disease treatment, nitinol stents remain the mainstay of therapy following balloon angioplasty popliteal artery (POPA). femoropopliteal in-stent restenosis remains an important clinical dilemma.
Materials and methods
A randomized controlled study, including 40 patients undergoing elective endovascular treatment for superficial femoral artery in stent restenosis (SFA ISR), was conducted to clarify the technical feasibility and the outcomes of the endovascular intervention.
Results
In total, 55% of cases were females (=22), 70% were diabetics (=28), 32.5% had a history of tobacco abuse (=13), 57.5% were hypertensive (=23), and 27.5% with past history of open revascularization (=11). Median age and per-procedural ankle brachial indices was 62 and 0.4, respectively. Procedural and clinical success was achieved in 32 limbs (80%). Failure of engagement occurred in eight patients with total occlusion of the stent (class III). The results for POPA alone versus combined drug-coated balloons and plain old balloon angioplasty (POBA) in relation to primary and secondary outcomes in successful cases at 3, 6, and 12 months of follow-up were usage of combined drug-coated balloons and POBA associated with increasing percentage of targeted outcomes (21.9, 30.4, and 54.5%, respectively) with significant value. Deployment of bare-metal nitinol stent was associated with improvement in primary and secondary outcomes at 3 and 6 months of follow-up (59.4 and 65.2%, respectively), but the percentage reduced at 12 months of follow-up into 54.5% (significant values 0.004, 0.009, and <0.001, respectively).
Conclusion
Endovascular treatment of in-stent occlusion is associated with high success rates and higher primary and secondary patency rates.

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