Treatment of longitudinal femoropopliteal vascular lesions with stents--report of individual cases

In a retrospective analysis the results of stent implantation in the superficial femoral and popliteal arteries were analysed. The stenoses were all larger than 10 cm in length. In 16 patients (3 women, 13 men, mean age 74 years) 15 occlusions and 2 stenoses (average lesion length 13.9 cm) in the superficial femoral and popliteal arteries were treated with stents. Prior to treatment, 11 patients were in clinical stage 2 b, 1 in stage 3, and 5 in stage 4 according to Fontaine. In 15 cases a wall stent was implanted and in 2 a wall stent combined with a nitinol stent since a wall stent of ideal length was not available. The patients received heparin through a venous lock during the operation and as infusion for 24 hours after the operation, as well as ticlopidine for 4 weeks and acetylsalicylic acid as long-term medication. All 17 lesions were recanalized without residual stenoses. After stent implantation the arterial system was completely restored in 3 limbs, 8 patients were in stage 1, 2 in stage 2 a, 2 in stage 2 b, and 1 still in stage 4 according to Fontaine. 8 patients suffered from a stent thrombosis (within 1 week, after 3 weeks, and after 3 months). 4 stents were treated by angioplasty 4 and 5 months after implantation for suspected intimal hyperplasia. According to Kaplan-Meier the primary patency rate after 12 months was 85% (+/- 12 SD), the secondary rate 76% (+/- 10 SD). The primary treatment of longer femoropopliteal lesions with stents does not result in a satisfactory primary patency rate. The patency rate after 1 year can be increased to 76% by strict monitoring and reintervention. The method may be recommended, albeit with limitations, for patients in whom a bypass operation is not possible or not desired.