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CURRENT ISSUETHE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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The Journal of Cardiovascular Surgery 2016 Jun 07

language: English

Primary stenting for TASC C and D femoropopliteal lesions: one-year results from a multicentric trial on 203 patients

Julie BROUILLET 1, Koen DELOOSE 2, Yann GOUËFFIC 3, Mathieu POIRIER 4, Dominique MIDY 1, Caroline CARADU 1, Eric DUCASSE 1

1 Unit of Vascular Surgery, Université De Bordeaux, Bordeaux, France; 2 Unit of Vascular Surgery, Dendermonde and Bonheiden, Belgium; 3 Unit of Vascular Surgery, Université de Nantes, Nantes, France; 4 Unit of Vascular Surgery, Mont-de-Marsan, France


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BACKGROUND: Recent advances in endovascular techniques have made it a seductive choice in the management of TASC C and D lesions. Currently, this tendency remains controversial, despite high success rates. The aim of the study was to regroup and harmo nize the results of three surgical teams in 5 centers in order to obtain the largest series ever published on TASC C and D femoro-popliteal lesions primary stenting.
METHODS: 203 patients and 209 lower limbs were included from March 2008 to October 2013. Each patient underwent primary stenting for TASC C or D femoro-popliteal lesions.
RESULTS: Mean age was 70 ± 10. 71.4% were male with 39.8% of coronary heart disease, 20.1% of renal insufficiency and 35.9% of diabetes. 57,4% suffered from claudication and 42.6% from critical limb ischemia (CLI). 61.8% of the 144 limbs analyzed for run-off presented with 3 patent infra-popliteal arteries. 403 stents were implanted in the 209 limbs included. Median stented length was 252 mm. Associated procedures were performed in 35 patients (17.0%) including 4.3% minor amputations. The 30-day mortality rate was 1.4% (3 patients). Major complications occurred in 19 patients (9.3%) including 7 patients (3.4%) presented with early in- stent thrombosis. Median follow-up duration was 12 months (range 9.5 - 17.2 months). The 12- month mortality rate was 11.8% (24 patients). The 3, 6 and 12 months primary patency rates according to Kaplan Meier estimates were 98.1 ± 0.9, 85.2 ± 2.5 and 67.0 ± 3.3% respectively. Secondary patency rates were 96.1 ± 1.9, 89.3 ± 3.0 and 75.7 ± 4.2% respectively. A subgroup analysis reported significantly higher patency rates for TASC C lesions compared to TASC D lesions (82,1% vs. 44% respectively, p = 0.009). The 12-month in-stent thrombosis and restenosis rates were 19.6% and 13.9% respectively. A subgroup analysis showed higher rates of in-stent restenosis for TASC D lesions compared to TASC C lesions (35 vs. 10% respectively, p = 0.005). The stent fracture rate was equal to 10.2%(30 stents). Occurrence of in-stent thrombosis and restenosis were associated with 3 and 5 cases of stent fracture (type II to IV) respectively. Freedom from TLR was 70.5%. Rutherford class decreased from 3,7 to 0,9 (3.52 ± 1.06 to 0.75 ± 1.24) (p < 0.0001). At 12 months 61,3%were asymptomatic, 33,3% suffered from claudication (21,3% Rutherford 1) and 5,4% suffered from CLI. Healing rates were 63.9% with a limb salvage rate of 95.5% and a major amputation rate of 3.8%.
CONCLUSIONS: This is the largest series of TASC C and D femoro-popliteal lesions primary stenting to our knowledge. The results are encouraging with acceptable primary patency and clinical improvement at 12 months. Results from mid- to long-term follow-up are awaited.

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