Long-term outcomes of SMART stent implantation in patients with femoro-popliteal disease

Objectives: This study aimed to determine the long-term outcomes of SMART stent implantation for femoro-popliteal (FP) lesions.

Background: The long-term results of SMART stent implantation for FP lesions remained unknown.

Methods: We studied 319 limbs in 269 patients (mean age: 73.2 ± 7.7 years) who underwent SMART stent implantation for FP lesions (mean treated-lesion length: 118.5 ± 81.0 mm) from 2004 to 2014, retrospectively. These patients were followed-up for a mean of 52.8 ± 33.8 months (median: 51.0 months). Kaplan-Meier and log-rank analyses were used to determine time to event. Hazard ratios (HRs) with 95% confidence interval (CI) were calculated through univariate and multivariate Cox proportional hazard analyses to estimate predictors of primary patency loss.

Results: Overall, 37.3% of lesions were TransAtlantic Inter-Society Consensus (TASC) IIC/D lesions, and 41.1% exhibited chronic total occlusion. Post-procedural primary patency rates were 87.7%, 79.4%, 68.1%, 53.7%, and 50.3%, at 1, 3, 5, 7, and 10 years, respectively; the corresponding secondary patency rates were 96.5%, 91.7%, 85.0%, 73.8%, and 67.7%, respectively. TASC IIA/B lesions had considerably better primary patency rates than C/D lesions at all time points. Multivariate analysis indicated that lesion length (with >200 mm vs. <100 mm) significantly promoted primary patency loss (HR, 2.555; 95% CI, 1.429-4.568; P = 0.002), as well as hemodialysis (HR, 1.881; 95% CI, 1.208-2.928; P = 0.005).

Conclusions: Although SMART stent implantation produced favorable long-term results, TASC IIC/D FP lesions had poor outcomes. © 2016 Wiley Periodicals, Inc.