Use of heparin coated vascular stents in femoropopliteal chronic total occlusions: Long term outcomes.

PURPOSE: To evaluate the long-term clinical efficacy of the Tigris © stent (Gore ©) in femoropopliteal chronic total occlusions (CTOs). MATERIAL AND METHODS: This single centre retrospective study included 29 patients treated with 47 Tigris© stents for CTOs. Lesion location, type, length, revascularisation method, smoking status and diabetes were reviewed. Clinical follow-up was performed. Primary safety points were complications and adverse events. Secondary efficacy points were symptom deterioration, freedom from target lesion revascularization (TLR) and amputation rate. Freedom from TLR was evaluated with Kaplan-Meier analysis; Cox multivariable logistic regression analysis of the factors associated with stent re-occlusion was also performed. RESULTS: All procedures were technically successful without any peri- or post-procedural complications and adverse events. Median follow-up was 48 months (range: 7-70). Lesions were located in the superficial femoral (19), popliteal (3) and femoropopliteal (7) arteries with mean lesion length 13.9 ±â€¯7.6 cm. In 12 patients subintimal recanalization was performed. Freedom from TLR rates at 6, 12, 18, 24 and 36 months were 96.6 %, 85.7 %, 81.9 %, 78.2 % and 74.3 % respectively. No stent fracture was observed and no amputation was performed in any of the patients. Smoking status, the presence of diabetes, lesion localization and recanalization type were not associated with stent re-occlusion. CONCLUSION: This study demonstrated that use of a heparin coated vascular stent for femoropopliteal CTOs appears to offer satisfactory long-term results.

Demystifying the Use of Self-Expandable Interwoven Nitinol Stents in Femoropopliteal Peripheral Arterial Disease.

Femoropopliteal atherosclerosis affects a significant percentage of the world population, leading to intermittent claudication and critical limb ischemia. The femoropopliteal segment has a unique set of biomechanical challenges that must be considered and overcome for treatment. The use of stents is a reality and a necessity in peripheral interventions. The success of first-generation femoropopliteal stents was limited by their rigidity and deformability. The standard nitinol stents overcame certain biomechanical challenges because of their superelasticity and thermal shape memory, although stent fracture is still an issue. Therefore, interwoven nitinol stents with helical structure have been developed, borrowing the concept from biliary stents, aiming to provide good flexibility while still maintaining a uniform cell size and significant radial strength. This unique interwoven structure gains it advantage in the femoropopliteal region. The purpose of this review article is to investigate the current published evidence of the use of self-expandable interwoven nitinol stents in femoropopliteal arterial disease and compare them with other endovascular treatment options.