Above and below knee femoropopliteal VIABAHN®.

ABSTRACT

OBJECTIVES: To assess the clinical outcomes of VIABAHN® stent grafts deployed across the knee to those deployed above the knee. BACKGROUND: The placement of stent-grafts across the knee joint and extending into the distal popliteal artery has been avoided due to a perceived higher risk of stent fractures, restenosis, and thrombosis due to the unique hemodynamic forces in this region. METHODS: A retrospective evaluation was conducted of 114 patients in 127 limbs. Patients were divided into two groups based on the location of the distal end of the deployed VIABAHN® stent above knee (AK) (n=89) in which the VIABAHN® implant ended at or above the femoral condyles and below the knee (BK) (n=38) with extension of the graft into the below knee popliteal segment. Study end points were loss of primary, assisted, and secondary patency. RESULTS: One year primary, assisted, and secondary patency rates in the AK versus BK group were 67.7% vs. 47.2% (P=0.0092), 77.1% vs. 53.7% (P=0.0022), and 86.3% vs. 59.8% (P=0.0035), respectively. Univariate analysis demonstrated an increased relative risk of a primary [RR=2.07 (P=0.001)], assisted [RR=2.34 (P=0.002)], or secondary events [RR=2.98 (P=0.002)] in patients when the stent was placed below the femoral condyles. Major amputations occurred in 10% of AK and 34% of BK patients (P=0.002). CONCLUSIONS: VIABAHN® stent grafts have a significantly lower clinical patency and higher rates of amputation when they extend across the knee joint.