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Long-term results of the Japanese multicenter Viabahn trial of heparin bonded endovascular stent grafts for long and complex lesions in the superficial femoral artery.

Authors
  • Ohki, Takao1
  • Kichikawa, Kimihiko2
  • Yokoi, Hiroyoshi3
  • Iida, Osamu4
  • Yamaoka, Terutoshi5
  • Maeda, Koji6
  • Kanaoka, Yuji7
  • 1 Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan. Electronic address: [email protected] , (Japan)
  • 2 Department of Radiology, Nara Medical University Hospital, Nara, Japan. , (Japan)
  • 3 Department of Cardiology, Fukuoka Sanno Hospital, Fukuoka, Japan. , (Japan)
  • 4 Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan. , (Japan)
  • 5 Department of Vascular Surgery, Matsuyama Red Cross Hospital, Ehime, Japan. , (Japan)
  • 6 Department of Vascular Surgery, International University of Health and Welfare Narita Hospital, Chiba, Japan. , (Japan)
  • 7 Department of Cardiovascular Surgery, Kawasaki Medical School, Okayama, Japan. , (Japan)
Type
Published Article
Journal
Journal of vascular surgery
Publication Date
Dec 01, 2021
Volume
74
Issue
6
Identifiers
DOI: 10.1016/j.jvs.2021.05.056
PMID: 34182032
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

We assessed the long-term safety and efficacy of endovascular stent grafting to treat long, complex lesions in the superficial femoral artery (SFA). The present prospective, multicenter study at 15 Japanese hospitals assessed heparin-bonded stent grafts used to treat long SFA lesions in patients with symptomatic peripheral arterial disease. The inclusion criteria were Rutherford category 2 to 5 symptoms (grade 5 without active infection), an ankle brachial index of ≤0.9, and SFA lesions ≥10 cm long with ≥50% stenosis. The key efficacy and safety outcomes were primary-assisted patency and adverse events through 24 months, respectively. The secondary outcomes included primary patency, secondary patency, freedom from target lesion revascularization (fTLR), and Vascular Quality of Life questionnaire score. Of the 103 patients (mean age, 74.2 ± 7.0 years; 82.5% male), 100 (97.1%) had intermittent claudication. The average lesion length was 21.8 ± 5.8 cm; 87 lesions (84.5%) were TASC (Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease) C or D (65.7% chronic total occlusions). Of the 103 patients, 92 and 61 were evaluable through 24 and 60 months, respectively. At 24 months, the Kaplan-Meier-estimated primary-assisted patency, primary patency, and secondary patency rate was 85.7% (95% confidence interval [CI], 76.3%-91.5%), 78.8% (95% CI, 68.8%-85.9%), and 92.0% (95% CI, 82.4%-96.5%), respectively. The mean ankle brachial index was 0.64 ± 0.12 at baseline and 0.94 ± 0.19 at 24 months (P < .0001). At 24 and 60 months, the fTLR was 87.2% (95% CI, 78.9%-92.3%) and 79.1% (95% CI, 67.9%-86.8%), respectively. No device- or procedure-related life- or limb-threatening critical events or acute limb ischemia cases were observed through 5 years. No stent fractures were detected on the annually scheduled follow-up radiographs. The vascular quality of life questionnaire and walking impairment questionnaire scores were significantly increased at 1 through 24 months compared with the baseline scores (P < .0001 for both). One patient had required conversion to open bypass during the 5-year follow-up period. Stent grafting of long and complex SFA lesions in patients with claudication is safe and effective through long-term follow-up, with 79.1% fTLR and no leg amputation, acute limb ischemia, or stent fractures through 5 years. Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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