Crossover stenting across the deep femoral artery entry: a multicenter retrospective study
- 78 Downloads
Abstract
Crossover stenting of femoral bifurcation raises the concern of jeopardizing the deep femoral artery (DFA) entry, thereby increasing future risk of limb-threatening ischemia and amputation. This retrospective multicenter study compared clinical outcomes of crossover stenting and non-crossover stenting for ostial superficial femoral artery (SFA) lesions. We reviewed 125 limbs in 103 patients with successful stent implantation for ostial SFA lesions and allocated them to two groups, based on whether the stent crossed over the DFA orifice (CO, n = 54) or not (NC, n = 71). The decision of applying whether CO or NC was at the operators’ discretion. Primary endpoints were incidences of major amputation and acute limb ischemia (ALI) at 24 months, and secondary endpoints were incidences of death, target lesion revascularization (TLR), composite of amputation or death, and major adverse limb events which was a composite of major amputation, ALI, TLR, or death at 24 months. Baseline characteristics were similar between the groups. Major amputation occurred only in the NC group, while ALI occurred only in the CO group. Kaplan–Meier estimation showed no significant differences in incidences of major amputation (NC: 3.0% vs. CO: 0.0%, p = 0.21), ALI, or any of the secondary endpoints. However, there was a trend towards higher incidence of ALI in the CO group (NC 0.0% vs. CO 3.9%, p = 0.11). Crossover stenting did not result in a significant difference in major amputation compared to non-crossover stenting within 24 months. However, it showed a trend towards higher incidence of ALI.
Keywords
Peripheral arterial disease Endovascular treatment Common femoral arteryNotes
Compliance with ethical standards
Funding
None.
Conflict of interest
All authors have no conflicts of interest to declare.
References
- 1.Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR, On behalf of the TASC II Working Group. Inter-Society Consensus Document on Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(suppl):S5–67.CrossRefGoogle Scholar
- 2.Kanda Y. Investigation of the freely-available easy-to-use software “EZR” (Easy R) for medical statistics. Bone Marrow Transpl. 2013;48:452–8.CrossRefGoogle Scholar
- 3.Kang JL, Patel VI, Conrad MF, Lamuraglia GM, Chung TK, Cambria RP. Common femoral artery occlusive disease: contemporary results following surgical endarterectomy. J Vasc Surg. 2008;48:872–7.CrossRefGoogle Scholar
- 4.Kechagias A, Ylonen K, Biancari F. Long-term outcome after isolated endarterectomy of the femoral bifurcation. World J Surg. 2008;32:51–4.CrossRefGoogle Scholar
- 5.Stricker H, Jacomella V. Stent-assisted angioplasty at the level of the common femoral artery bifurcation: midterm outcomes. J Endovasc Ther. 2004;11:281–6.CrossRefGoogle Scholar
- 6.Cotroneo AR, Iezzi R. The role of ‘‘cutting’’ balloon angioplasty for the treatment of short femoral bifurcation steno-obstructive disease. Cardiovasc Interv Radiol. 2010;33:921–8.CrossRefGoogle Scholar
- 7.Baumann F, Ruch M, Willenberg T, Dick F, Do DD, Keo HH, Baumgartner I, Diehm N. Endovascular treatment of common femoral artery obstructions. J Vasc Surg. 2011;53:1000–6.CrossRefGoogle Scholar
- 8.Bonvini RF, Rastan A, Sixt S, Noory E, Schwarz T, Frank U, Roffi M, Dorsaz PA, Schwarzwälder U, Bürgelin K, Macharzina R, Zeller T. Endovascular treatment of common femoral artery disease: medium-term outcomes of 360 consecutive procedures. J Am Coll Cardiol. 2011;58:792–8.CrossRefGoogle Scholar
- 9.Yamawaki M, Hirano K, Nakano M, Sakamoto Y, Takimura H, Araki M, Ishimori H, Ito Y, Tsukahara R, Muramatsu T. Deployment of self-expandable stents for complex proximal superficial femoral artery lesions involving the femoral bifurcation with or without jailed deep femoral artery. Catheter Cardiovasc Interv. 2013;81:1031–41.CrossRefGoogle Scholar
- 10.Hong SJ, Ko YG, Suh Y, Shin DH, Kim JS, Kim BK, Hong MK, Jang Y, Choi D. Outcomes of stents covering the deep femoral artery origin. Eurointervention. 2014;10:632–9.CrossRefGoogle Scholar
- 11.Iida O, Takahara M, Soga Y, Nakano M, Yamauchi Y, Zen K, Kawasaki D, Nanto S, Yokoi H, Uematsu M, ZEPHYR Investigators. 1-year results of the ZEPHYR registry (Zilver PTX for the femoral artery and proximal popliteal artery): predictors of restenosis. J Am Coll Cardiol Cardiovasc Interv. 2015;8:1105–12.CrossRefGoogle Scholar
- 12.Ohki T, Angle JF, Yokoi H, Jaff MR, Popma J, Piegari G. Kanaoka Y; OSPREY investigators. OSPREY investigators. One-year outcomes of the U.S. and Japanese regulatory trial of the Misago stent for treatment of superficial femoral artery disease (OSPREY study). J Vasc Surg. 2016;63:370–6.CrossRefGoogle Scholar