Cheban AV, Osipova OS, Ignatenko PV, Bugurov SV, Gostev AA, Saaya SB, Rabtsun AA, Karpenko AA. One-year results of long femoropopliteal lesions stenting with fasciotomy lamina vastoadductoria.
Ann Vasc Surg 2022;
88:100-107. [PMID:
36058457 DOI:
10.1016/j.avsg.2022.07.032]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/06/2022] [Accepted: 07/31/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE
Fasciotomy can increase the mobility of the superficial femoral artery and decrease the incidence of stent fractures. This study aimed to compare the long-term patency of drug-eluting nitinol stents with and without fasciotomy in patients with prolonged SFA occlusions.
METHODS
A randomized clinical trial was conducted in 60 (1:1) patients with long femoropopliteal steno-occlusive lesions more than 200 mm. Patients in group 1 (Zilver) underwent recanalization of femoropopliteal artery occlusion with stenting. In group 2 (ZilverFas), the femoropopliteal occlusion was recanalized with stenting and fasciotomy of Gunter's canal. The follow-up assessment of the patency took place after 6, 12 months.
RESULTS
12-month primary patency in Zilver and ZilverFas groups was 51% and 80%, respectively (p = 0.02). The freedom from target revascularization (TLR) in Zilver and ZilverFas groups was 50% and 76%, respectively (p = 0.04). At one-year, primary-assisted and secondary patency for the ZilverFas and Zilver groups were 83% versus 62% (p = 0.07), 86% versus 65% (p = 0.05), respectively. In Zilver and ZilverFas groups, the number of stents fractures was 14 and 7, respectively (p = 0.05). The multivariables Cox regression indicated that the stent fracture and diabetes mellitus were the independent predictors of restenosis and reocclusion. Fasciotomy reduced the risk of reocclusion and restenosis by 2.94 times.
CONCLUSIONS
Our study has shown that a decompressing the stented segment with fasciotomy significantly improves the patency of the femoropopliteal segment and significantly reduces the number and severity of stent fractures.
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