Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492006000400005
Jornal Vascular Brasileiro
Original Article

Recanalização da artéria femoral superficial com stents Zilver: técnica padronizada e análise retrospectiva de 3 anos

Superficial femoral artery recanalization with Zilver stents: standard technique and 3-year retrospective analysis

Marcelo Ferreira; Luis Fernando Capotorto; Giafar Abuhadba; Marcelo Monteiro; Luiz Lanziotti

http://dx.doi.org/10.1590/S1677-54492006000400005 J Vasc Bras, vol.5, n4, p.263-270, 2006
PDF
Downloads: 0
Views: 1200

Resumo

OBJETIVOS: Descrever a técnica de recanalização endovascular da artéria femoral superficial e fazer uma análise retrospectiva dos 3 primeiros anos da técnica. MÉTODOS: Análise retrospectiva dos pacientes tratados entre 2001 e 2004, visando obter as taxas de perviedade das recanalizações. A amostra considerada neste estudo consta de 79 artérias femorais superficiais recanalizadas em 61 pacientes, nos quais foram utilizados exclusivamente a técnica descrita e o mesmo modelo de stent de nitinol auto-expansível (Zilver, COOK). RESULTADOS: Dos 61 pacientes, 8% possuíam isquemia crítica de membro inferior e 92% apresentavam claudicação incapacitante refratária ao tratamento clínico. A melhora clínica foi observada e referida pelos pacientes numa relação direta à perviedade das recanalizações. A análise estatística demonstrou taxas acumuladas de perviedade primária assistida de 98, 91 e 84% em 12, 24 e 37 meses, respectivamente. As taxas de perviedade, entendida como fluxo continuado nas recanalizações, foram de 96, 93 e 93% em 12, 24 e 37 meses, respectivamente. CONCLUSÕES: Consideramos a técnica da recanalização da artéria femoral superficial um método ao mesmo tempo pouco invasivo, com reduzidas complicações e de consideráveis taxas de sucesso anatômico e perviedade, que, em conjunto, são capazes de proporcionar satisfação e qualidade de vida aos pacientes portadores de doença arterial obstrutiva periférica.

Palavras-chave

Artéria femoral, angioplastia, stents, claudicação intermitente

Abstract

OBJECTIVES: To describe the endovascular recanalization technique of the superficial femoral artery and perform a 3-year retrospective analysis of the technique. METHODS: Retrospective analysis of the patients treated between 2001 and 2004, with the aim of obtaining the patency rates of the recanalizations. The sample consisted of 79 recanalized superficial femoral arteries in 61 patients, exclusively using the described technique and the same nitinol self-expanding stent model (Zilver, COOK). RESULTS: Of the 61 patients, 8% had critical lower limb ischemia and 92% had incapacitating claudication refractory to the clinical treatment. Clinical improvement was observed and reported by the patients in a direct correlation with the recanalization patency. The statistical analysis showed accumulated assisted primary patency rates of 98, 91 and 84% in 12, 24 and 37 months, respectively. The patency rates, considered as the continuous flow in the treated area, were 96, 93 and 93% in 12, 24 and 37 months, respectively. CONCLUSIONS: We consider the recanalization technique of the superficial femoral artery a less invasive method, with few complications and considerable anatomic success and patency rates, which are able of promoting satisfaction and quality of life to patients with peripheral obstructive arterial disease.

Keywords

Femoral artery, angioplasty, stents, intermittent, claudication

References

Sousa JE, Costa MA, Abizaid AC. Sustained suppression of neointimal proliferation by sirolimus-eluting stents: one-year angiographic and intravascular ultrasound follow-up. Circulation. 2001;104:2007-11.

Sousa JE, Costa MA, Abizaid A. Lack of neointimal proliferation after implantation of sirolimus-coated stents in human coronary arteries: a quantitative coronary angiography and three-dimensional intravascular ultrasound study. Circulation. 2001;103:192-5.

Marx SO, Jayaraman T, Go LO, Marks AR. Rapamycin-FKBP inhibits cell cycle regulators of proliferation in vascular smooth muscle cells. Circ Res.. 1995;76:412-7.

Poon M, Marx SO, Gallo R, Badimon JJ, Taubman MB, Marks AR. Rapamycin inhibits vascular smooth muscle cell migration. J Clin Invest.. 1996;98:2277-83.

Duda SH, Pusich B, Richter G. Sirolimus-eluting stents for the treatment of obstructive superficial femoral artery disease: six-month results. Circulation. 2002;106:1505-9.

Henry M, Klonaris C, Amor M, Henry I, Tzvetanov K. State of the art: which stent for which lesion in peripheral interventions?. Tex Heart Inst J.. 2000;27:119-26.

Hoffmann R, Mintz GS, Dussaillant RG. Patterns and mechanisms of in stent restenosis: a serial intravascular ultrasound study. Circulation. 1996;94:1247-54.

Davies MG, Waldman DL, Pearson TA. Comprehensive endovascular therapy for femoropopliteal arterial atherosclerotic occlusive disease. J Am Coll Surg.. 2005;201:275-96.

Oliva VL, Soulez G. Sirolimus-eluting stents versus the superficial femoral artery: second round. J Vasc Interv Radiol.. 2005;16:313-5.

Lee C, Tan H, Lim Y. Update on drug-eluting stents for prevention of restenosis. Asian Cardiovasc Thorac Ann.. 2006;14:75-82.

Duda SH, Poerner TC, Wiesinger B. Drug-eluting stents: potential applications for peripheral arterial occlusive disease. J Vasc Interv Radiol.. 2003;14:291-301.

Heldman AW, Cheng L, Jenkins GM. Paclitaxel stent coating inhibits neointimal hyperplasia at 4 weeks in a porcine model of coronary restenosis. Circulation. 2001;103:2289-95.

Scheinert D, Scheinert S, Sax J. Prevalence and clinical impact of stent fractures after femoropopliteal stentin. J Am Coll Cardiol. 2005;45:312-5.

Sacks D, Marinelli DL, Martin LG. Reporting standards for clinical evaluation of new peripheral arterial revascularization devices. J Vasc Interv Radiol.. 2003;14:S395-404.

Hong MK, Kornowski R, Bramwell O, Ragheb AO, Leon MB. Paclitaxel-coated Gianturco-Roubin II (GR II) stents reduce neointimal hyperplasia in a porcine coronary in-stent restenosis model. Coron Artery Dis.. 2001;12:513-5.

Zdanowski Z, Albrechtsson U, Lundin A. Percutaneous transluminal angioplasty with or without stenting for femoropopliteal occlusions?: A randomized controlled study. Int Angiol.. 1999;18:251-5.

Vroegindeweij D, Vos LD, Tielbeek AV, Buth J, vd Bosch HC. Balloon angioplasty combined with primary stenting versus balloon angioplasty alone in femoropopliteal obstructions: A comparative randomized study. Cardiovasc Intervent Radiol.. 1997;20:420-5.

Chatelard P, Guibourt C. Long-term results with a Palmaz stent in the femoropopliteal arteries. J Cardiovasc Surg (Torino). 1996;37(3^s1):67-72.

Sapoval MR, Long AL, Raynaud AC, Beyssen BM, Fiessinger JN, Gaux JC. Femoropopliteal stent placement: long-term results. Radiology. 1992;184:833-9.

Liermann D, Strecker EP, Peters J. The Strecker stent: indications and results in iliac and femoropopliteal arteries. Cardiovasc Intervent Radiol.. 1992;15:298-305.

Strecker EP, Boos IB, Gottmann D. Femoropopliteal artery stent placement evaluation of long-term success. Radiology. 1997;205:375-83.

Management of peripheral arterial disease (PAD) TransAtlantic Inter-Society Consensus (TASC). Eur J Vasc Endovasc Surg.. 2000;19(^sA):1-244.

Karch LA, Mattos MA, Henretta JP, McLafferty RB, Ramsey DE, Hodgson KJ. Clinical failure after percutaneous transluminal angioplasty of the superficial femoral and popliteal arteries. J Vasc Surg.. 2000;31:880-7.

Vroegindeweij D, Tielbeek AV, Buth J, van Kints MJ, Landman GH, Mali WP. Recanalization of femoropopliteal occlusive lesions: a comparison of long-term clinical, color duplex US, and arteriographic follow-up. J Vasc Interv Radiol.. 1995;6:331-7.

Surowiec SM, Davies MG, Eberly SW. Percutaneous angioplasty and stenting of the superficial femoral artery. J Vasc Surg.. 2005;41:269-78.

el-Bayar H, Roberts A, Hye R, Davis G, Freischlag J. Determinants of failure in superficial femoral artery angioplasty. Angiology. 1992;43:877-85.

Schlager O, Dick P, Sabeti S. Long-segment SFA stenting-the dark sides: in-stent restenosis, clinical deterioration, and stent fractures. J Endovasc Ther.. 2005;12:676-84.

Palmaz JC. Intravascular stents in the last and the next 10 years. J Endovasc Ther.. 2004:II200-6.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5de95b390e8825a267e31d43 jvb Articles
Links & Downloads
1677-7301 (Electronic)
J Vasc Bras ©2024 All rights reserved.

J Vasc Bras

Share this page
Page Sections