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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2012 Giugno;19(2):103-8
Bail out stenting for treatment of below the knee arterial disease: acute results and one-year follow-up. A single center experience
Cioppa A., Stabile E., Salemme L., Ambrosini V., Sorropago G., Tesorio T., Popusoi G., Cota L., Sarno G., Biamino G., Rubino P.
Division of Invasive Cardiology, “Montevergine” Clinic, Mercogliano, Avellino, Italy
Aim. Recent studies support the role of percutaneous revascularization (PTA) in patients with critical limb ischemia (CLI) and life limiting claudication (LLC) due also to infragenicular atherosclerotic disease. However, as PTA may result in persistent residual stenosis and flow limiting dissections stent implantation is often necessary to obtain procedural success. We report our experience with a bailout stenting approach for the treatment of below the knee (BTK) arterial disease.
Methods. From June 2006 to February 2010, 220 patients underwent PTA of BTK arteries in our institution due to CLI (122 [72.5%]) and life LLC (58 [27.5%]). Within this cohort, 80 patients underwent stent implantation due to suboptimal result of PTA with a total of 80 stents dedicated for infragenicular use (Chromis Deep stents, Invatec, Roncadelle, BS, Italia). After intervention patients were followed at 1, 6 and 12 month intervals with clinical examination and arterial duplex study.
Results. Procedural success was achieved in all 80 patients (100%). At 12 month follow up (386±101 days), no major or minor amputations occurred in any patient with CLI, yielding a limb salvage rate of 100%. All patients showed initial clinical improvement in Rutherford class (from 5 to 3, P<0.01) and in ABI Index (from 0.32±0.10 to 0.75±0.14, P<0.001). At 6 month follow-up 22 patients (28%) developed a worsening symptoms leading to a new angiographic procedure and a new PTA in 18 patients (23%). Four patients were planned for medical treatment.
Conclusion. This single center registry suggests that bailout stenting, with a dedicated stent for infragenicular use, is feasible and safe, and provides favourable one-year clinical results in patients with CLI or LLI.