The role of superficial femoral artery endoluminal bypass in long de novo lesions and in-stent restenosis

Abstract

Aim: Results of endovascular treatment for long de novo lesions of the superficial femoral artery (SFA) are limited by in-stent restenosis (ISR). Polytetrafluoroethylene (PTFE) covered stents are developed to reduce the incidence of ISR. This study was conducted to summarize available data on the use of endoprosthesis in the treatment of SFA occlusive disease and to evaluate their use in the treatment of ISR.

Methods: A systematic literature search was performed, using MEDLINE, EMBASE and Cochrane databases. Reports on the application of Hemobahn® and Viabahn® endoprosthesis in the treatment of long de-novo lesions and ISR of the SFA were included.

Results: A total of 19 articles were included. Technical success rates varied between 95-100%. Case series have shown 1-year primary patency rates varying between 44% and 86%, with secondary patency rates between 58% and 93%. Large differences in patient and lesion characteristics, medical therapy and developments in stent-graft design complicate comparisons between studies. Randomized studies have shown a superiority of the endoprosthesis above angioplasty only and similar patency rates with above-knee prosthetic femoro-popliteal bypass up to 48 months. Data on the use of endografts for ISR are scarce.

Conclusion: The use of an endoprosthesis for SFA occlusive disease is an effective and safe treatment strategy for long de novo lesions. Patient selection and adequate medical support appear to be important in achieving long term patency. Data focusing on the effectiveness of endoprosthesis for ISR are still limited.