Background: We report our experience on the technical feasibility and impact on quality of life (QOL) for angioplasty and primary stenting of chronic total occlusion (CTO) of the superficial femoral artery (SFA).
Methods: Forty-four patients (51 legs) underwent attempted percutaneous revascularization for SFA CTO utilizing the self-expanding nitinol SMART stent (Cordis Corp., Miami, Florida). The Walking Impairment Questionnaire (WIQ score range: 0 to 14,080) was used to assess quality of life and ankle-brachial indices (ABI) were obtained pre- and post-procedure.
Results: Successful revascularization was achieved in 90.2% of the cases; Mean follow up was 374 +/- 321 days. The mean occlusion length was 15.5 +/- 9.9 cm; the mean stented segment length was 23.2 +/- 12.2 cm. The minimum stent diameter averaged 7.0 +/- 0.6 mm, and the maximum final balloon diameter averaged 5.9 +/- 0.6 mm. The mean pre- and post-intervention WIQ scores were 722 +/- 1503, and 8,421 +/- 5,741 (p < 0.0005), respectively. The mean delta-WIQ was 7,405 (95% CI: 6,555 to 9,245). The mean pre- and post-intervention ABI were 0.61 +/- 0.18, and 0.91 +/- 0.19 (p < 0.0005), respectively. The mean delta-ABI was 0.27 (95% CI: 0.21 to 0.33). The clinically-driven target lesion revascularization rate at 12 months was 11.8%.
Conclusions: Chronically occluded SFAs can be treated by percutaneous nitinol stenting techniques with a high degree of success that is durable at 12-month follow up. Patients have a significant improvement in QOL and ABI. Repeat revascularization rates are reasonably low, and parallel the historical surgical data.