Clinical Impact of Stent Graft Thrombosis in Femoropopliteal Arterial Lesions

This study sought to elucidate the clinical impact and prognosis of stent graft (SG) thrombosis. The VIABAHN SG offers a favorable outcome in long peripheral artery occlusive disease (PAOD) lesions in the femoropopliteal artery. One concern after SG deployment is the incidence of stent thrombosis an...

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Bibliographic Details
Published in:JACC. Cardiovascular interventions 2021-05, Vol.14 (10), p.1137-1147
Main Authors: Ichihashi, Shigeo, Takahara, Mitsuyoshi, Iida, Osamu, Suzuki, Kenji, Yamaoka, Terutoshi, Maeda, Koji, Tobita, Kazuki, Kobayashi, Taira, Nakama, Tatsuya, Shingaki, Masami, Ozaki, Shunsuke, Akagi, Daisuke, Soga, Yoshimitsu, Iwakoshi, Shinichi, Fujimura, Naoki, Kichikawa, Kimihiko
Format: Article
Language:English
Subjects:
acute limb ischemia
femoropopliteal
peripheral arterial occlusive disease
stent graft
stent thrombosis
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Summary:This study sought to elucidate the clinical impact and prognosis of stent graft (SG) thrombosis. The VIABAHN SG offers a favorable outcome in long peripheral artery occlusive disease (PAOD) lesions in the femoropopliteal artery. One concern after SG deployment is the incidence of stent thrombosis and consequent acute limb ischemia (ALI). In this retrospective multicenter study, we collected the clinical data of PAOD patients treated with VIABAHN SG who subsequently experienced SG thrombosis. The clinical symptoms of SG thrombosis, patency after reintervention, and predictors of loss of patency after reintervention were examined. VIABAHN SGs were used for 1,215 patients; SG thrombosis occurred in 159 (13%) patients at a median of 6.4 months (interquartile range: 2.8 to 13.5 months) after SG implantation; 21 (13%) patients presented with ALI. A total of 131 (82%) patients underwent reintervention for SG thrombosis, whereas 2 (1%) underwent primary major amputation and the remaining 26 (16%) were treated conservatively. The patency rate 1 year after reintervention, freedom from major adverse limb events, and limb salvage after reintervention were 54.9%, 73.6%, and 92.5%, respectively. Critical limb-threatening ischemia at SG implantation and ALI presentation at SG thrombosis were positively associated with an increased risk of rethrombosis, whereas distal stent diameter was negatively associated with the risk of rethrombosis. SG thrombosis is associated with a considerable risk of ALI, but the risk of primary major amputation was not high. Clinical outcomes after reinterventions for thrombosed SGs were suboptimal. [Display omitted]
ISSN:1936-8798
1876-7605
DOI:10.1016/j.jcin.2021.03.030