Endovascular Stent-Grafting in the Treatment of Superficial Femoral Artery Occlusive Disease

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Abstract
Purpose: To explore the feasibility of using a flexible stent-graft in the treatment of superficial femoral artery occlusive lesions. Methods: Thirty-five patients (26 men; median age 65 years, range 41–85) with long-segment occlusions of the femoropopliteal arteries were treated with the Hemobahn endovascular prosthesis. The median occlusion length was 22 cm (range 4–40). Endografting was performed in conjunction with additional recanalization procedures as needed. Results: Primary recanalization and deployment of 47 Hemobahn endografts was successful in all cases; 12 patients had 2 devices implanted. The adjunctive recanalization techniques included balloon thrombectomy (n = 28), ring-stripper disobliteration (n = 7), local thrombolysis (n = 2), mechanical rotational thrombectomy (n = 2), local thromboendarterectomy and femoral bifurcation patch angioplasty (n = 14), iliac artery stenting (n = 3), and bypass grafting (n = 2). The median ankle-brachial index rose from 0.25 preoperatively to 0.87. Over an average 7-month follow-up (range 1–18), 10 (28.6%) occlusions occurred; 6 stent-graft thromboses were treated successfully with thrombectomy only. The other 4 occlusions were permanent. Life-table analysis documented cumulative primary and secondary patency rates of 73.2% and 82.6%, respectively, at 1 year. Conclusions: Intraoperative use of the Hemobahn endograft is feasible and effective in restoring adequate distal perfusion in the short term, especially when combined with conventional recanalization techniques.