Shigeo Ichihashi1, Mitsuyoshi Takahara2, Osamu Iida3, Kenji Suzuki4, Terutoshi Yamaoka5, Koji Maeda6, Kazuki Tobita7, Taira Kobayashi8, Tatsuya Nakama9, Masami Shingaki10, Shunsuke Ozaki11, Daisuke Akagi12, Yoshimitsu Soga13, Shinichi Iwakoshi14, Naoki Fujimura15, Kimihiko Kichikawa14. 1. Department of Radiology, Nara Medical University, Kashihara, Japan. Electronic address: shigeoichivasc@gmail.com. 2. Department of Diabetes Care Medicine, Graduate School of Medicine, Osaka University, Suita, Japan. 3. Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan. 4. Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan. 5. Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan. 6. Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan. 7. Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan. 8. Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi, Japan. 9. Department of Cardiology, Tokyo Bay Medical Center, Urayasu, Japan. 10. Department of Cardiovascular Surgery, Hakodate Municipal Hospital, Hakodate, Japan. 11. Department of Cardiology, Itabashi Chuo Medical Center, Tokyo, Japan. 12. Department of Vascular Surgery, Tokyo Metropolitan Geriatric Medical Center, Tokyo, Japan. 13. Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan. 14. Department of Radiology, Nara Medical University, Kashihara, Japan. 15. Division of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan.
Abstract
OBJECTIVES: This study sought to elucidate the clinical impact and prognosis of stent graft (SG) thrombosis. BACKGROUND: The VIABAHN SG offers a favorable outcome in long peripheral artery occlusive disease (PAOD) lesions in the femoropopliteal artery. One concern after SG deployment is the incidence of stent thrombosis and consequent acute limb ischemia (ALI). METHODS: In this retrospective multicenter study, we collected the clinical data of PAOD patients treated with VIABAHN SG who subsequently experienced SG thrombosis. The clinical symptoms of SG thrombosis, patency after reintervention, and predictors of loss of patency after reintervention were examined. RESULTS: VIABAHN SGs were used for 1,215 patients; SG thrombosis occurred in 159 (13%) patients at a median of 6.4 months (interquartile range: 2.8 to 13.5 months) after SG implantation; 21 (13%) patients presented with ALI. A total of 131 (82%) patients underwent reintervention for SG thrombosis, whereas 2 (1%) underwent primary major amputation and the remaining 26 (16%) were treated conservatively. The patency rate 1 year after reintervention, freedom from major adverse limb events, and limb salvage after reintervention were 54.9%, 73.6%, and 92.5%, respectively. Critical limb-threatening ischemia at SG implantation and ALI presentation at SG thrombosis were positively associated with an increased risk of rethrombosis, whereas distal stent diameter was negatively associated with the risk of rethrombosis. CONCLUSIONS: SG thrombosis is associated with a considerable risk of ALI, but the risk of primary major amputation was not high. Clinical outcomes after reinterventions for thrombosed SGs were suboptimal.
OBJECTIVES: This study sought to elucidate the clinical impact and prognosis of stent graft (SG) thrombosis. BACKGROUND: The VIABAHN SG offers a favorable outcome in long peripheral artery occlusive disease (PAOD) lesions in the femoropopliteal artery. One concern after SG deployment is the incidence of stent thrombosis and consequent acute limb ischemia (ALI). METHODS: In this retrospective multicenter study, we collected the clinical data of PAOD patients treated with VIABAHN SG who subsequently experienced SG thrombosis. The clinical symptoms of SG thrombosis, patency after reintervention, and predictors of loss of patency after reintervention were examined. RESULTS: VIABAHN SGs were used for 1,215 patients; SG thrombosis occurred in 159 (13%) patients at a median of 6.4 months (interquartile range: 2.8 to 13.5 months) after SG implantation; 21 (13%) patients presented with ALI. A total of 131 (82%) patients underwent reintervention for SG thrombosis, whereas 2 (1%) underwent primary major amputation and the remaining 26 (16%) were treated conservatively. The patency rate 1 year after reintervention, freedom from major adverse limb events, and limb salvage after reintervention were 54.9%, 73.6%, and 92.5%, respectively. Critical limb-threatening ischemia at SG implantation and ALI presentation at SG thrombosis were positively associated with an increased risk of rethrombosis, whereas distal stent diameter was negatively associated with the risk of rethrombosis. CONCLUSIONS:SG thrombosis is associated with a considerable risk of ALI, but the risk of primary major amputation was not high. Clinical outcomes after reinterventions for thrombosed SGs were suboptimal.