The Effect of Stenting on Patency and Limb Salvage in Cases of TASC D Femoropopliteal Disease in Critical Limb Ischemia

The aim was to evaluate the effect of stenting on patency and limb salvage in cases of TASC D femoropopliteal disease in critical limb ischemia patients. This prospective study included 51 patients presented to the Vascular Surgery Department in Kasr Al-Aini and New Kasr Al-Aini Teaching Hospitals with femoropopliteal disease for whom endovascular revascularization was done, between January 2013 and January 2014. Patients and Methods: Angiography was performed under systemic heparin administration (5000 IU) through the sheath. SIA, trying to achieve re-entry. If reentry was not successful, a transpopliteal approach is used and if still reentry was not successful a reentry device is used. Once the lesion is crossed, the guiding catheter is ex-changed for a 5- or 6-mm-diameter 5-French balloon catheter. Refractory stenoses may require placement of Self-Expandable Peripheral Nitinol Stents in the affected region. During the procedure, a systemic 1000 IU Heparin was given per hour. Clinical follow-up and duplex examination at 1 month, 6 months, and 12 months after the procedure were done. It included follow-up of pulse examination, evaluation of the claudication pain and rest pain, evaluation of ulcer or amputation site healing or resolution of infection. Results: Technical success was achieved in 90.2% of patients who underwent endovascular of TASCD lesions. Patients who underwent failed attempts at endovascular intervention for a TASC D lesion were not included in the subsequent outcomes analysis. Seventeen limbs (31.3%) required an ante grade approach to facilitate successful recanalization. Follow-up length was 12 months excluding five patients who were technically failed one patient who expired in the hospital one week post oprative. Another one died during follow-up. There were 26.5% major amputations during the follow-up 14.3% in the firest three months post operative. 18.4% above knee amputation 4.1% below knee amputation 4.1% 30 limbs (59%) experienced restenosis (21 limbs) or occlusions (9 limbs). By survival curve analysis, primary patency was 75% at 6 months and 45.5% at 12 months. 20 limbs (40%) underwent reintervention during the follow-up time. All patients had duplex findings consistent with restenosis or occlusion prior to reintervention. The mean time to reintervention was 6 months. 5 limbs (10%) required multiple reinterventions including 2 limbs which underwent 3 reinterventions, 3 limbs which underwent 2 reinterventions, secondary patency rates by survival curve analysis were 59.1% at 12 months. Of the 28 limbs which suffered occlusion, 7 limbs underwent successful endovascular salvage, 2 were observed following complete wound healing in the affected limb, and 3 went on to surgical bypass. Among the patients who underwent surgical bypass, there were 2 femoral-to-below-knee popliteal artery bypasses performed for early occlusions (at 6 months), endovascular interventions. Secondary patency rates by survival curve analysis were 59.1% at 12 months. There was no significant difference in primary, assisted primary, or secondary patency between patients who underwent their initial intervention for CLI (p.84 p.73, and p. 42, respectively)