Original title: Deployment of Self-Expandable Stents for Complex Proximal Superficial Femoral Artery Lesions Involving the Femoral Bifurcation With Or Without Jailed Deep Femoral Artery. Reference: Masahiro Yamawaki et al. Catheterization and Cardiovascular Interventions 81:1031–1041 (2013).
The endovascular management of chronic total occlusions of the lower extremities has seen great progress over the past years; however, specific segments require further consideration. Endovascular treatment of ostial lesions of the superficial femoral artery compromising the common superficial and deep femoral bifurcation requires further consideration. This segment has been systematically excluded from randomized studies that compare balloon angioplasty vs. stenting because jailed deep femoral artery after distal stenting is not considered safe, which results in the prevalence of surgery as preferred option.
The aim of this study was to compare the safety and efficacy of self expandable stenting with jailed DFA, vs. ostial SFA stenting. The FB (femoral bifurcation) was defined as the segment beginning in the distal CFA, 10 mm proximal to the DFA ostium and ending in the SFA and 10 mm distal to the carina. 104 consecutive, de novo lesions involving the SFA ostium were included: 60 (57.7%) distal common femoral artery (CFA) stenting with jailed DFA and 44 (43.3%) ostial SFA stenting without jailed DFA.
At 12 months follow up, bifurcation patency was higher after distal CFA stenting with jailed DFA (83.3% vs. 56.3%; P < 0.01). In the same period, though not significantly, primary patency was also higher. Globally, repeat revascularization at 12 months was 34.2% (28.9% percutaneous and 5.4% surgical).
Conclusion:
Patency after self-expandable stenting with jailed deep femoral artery (DFA) for proximal superficial femoral artery (SFA) lesions was acceptable and was also associated with higher bifurcation patency when compared to ostial SFA stenting.
Editorial Comment:
When treating the compromised femoral bifurcation, given the success of endarterectomy and patch angioplasty, both the center where this study was carried out and the current guidelines are for the surgical management; this is why all patients included in this study were either non surgical or had simply refused surgery. Endovascular management of CFA is usually avoided in this highly mobile area because of the risk of stent fracture, pain or thrombosis. The fact that lesions are not completely covered probably explains the lower patency of ostial SFA stenting.
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