Management of De novo Long Femoropopliteal Occlusions; Plain Balloon, Drug Coated Balloon, Bare Metal Stent; Comparative Study
Journal Title: INTERNATIONAL JOURNAL OF CURRENT RESEARCH IN MEDICAL SCIENCES - Year 2019, Vol 5, Issue 6
Abstract
Aim of work: To compare the results of plain balloon (PB), drug coated balloon (DCB) and bare metal stent in management of de novo long femoropopliteal occlusive lesions. Methods: This prospective study was carried out from January 2016 to December 2018 at Sohag University Hospitals and 6th October Insurance Hospital, Dokki, Cairo on 70 patients suffered from de novo femoropopliteal occlusions ≥10 cm, Rutherford category 3,4,5 divided in 3 groups. Group (A) consisted of 30 patients (17 males, 13 females) with a mean age of 57 years (ranged from 50 - 64 years) treated by plain balloon angioplasty. Group (B) consisted of 22 patients (12 males, 10 females) with a mean age of 61 years (ranged from 52 - 65 years) treated by DCB and group (C) consisted of 18 patients (10 males, 8 females) with a mean age of 59 years (ranged from 49 - 65 years) treated with long bare metal nitinol stent. Lesion length was 15.1±2.7 cm in group (A), 14.2±3.6 cm in group (B) &15.3±2.8 cm in group (C). There were no significant differences between groups in age, gender and risk factors. Subjects were scheduled to be evaluated and followed up for one year. Results: In group (A) (plain balloon group), primary patency rate was 53.8% (14/26) patients. 12 patients (46.2%) developed significant stenosis. (4/12) patients continued medically as they were claudicant. (8/12) had critically ischemic limb, 3 cases were treated by DCB angioplasty, one patient by stent, 2 patients by femoropopliteal bypass and 2 cases ended by limb amputation. Bailout stenting was performed in 4/30 (13.3%) lesions due to flow limiting dissection and those patients were shifted from this group to group (C) of stent group. In DCB patients (group B), primary patency rate was 76.4% (13/17) patients. Four patients (23.5%) developed significant stenosis. One patient continued medically, one case was treated by DCB angioplasty and stent, one patient treated by femoropopliteal bypass and the 4th one ended by limb amputation. Bailout stenting was performed in 5/22 cases (22.7%). In group (C) of long bare metal stent, primary patency rate was 63.6%.(14/22) patients. Eight patients (36.4%) developed in-stent stenosis. 2 cases treated conservatively, 4 patients treated by DCB angioplasty, one treated by femoropopliteal bypass and the other one ended by amputation. The clinically driven target lesion revascularization (TLR) rates were 30.8%, 17.6% and 27.3 % respectively. It was statistically significant difference between the study cohorts, (p-value ˂ 0.01). Conclusions: DCB angioplasty yields better results and comparable outcomes compared to bare metal stents when treating long femoropopliteal occlusions. Because the nature of peripheral occlusive disease is progressive, it is wise to apply DCB angioplasty first and reserve the stent as a future option later on.
Authors and Affiliations
Osama A. Ismail
Keywords
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- EP ID EP575344
- DOI 10.22192/ijcrms.2019.05.06.001
- Views 136
- Downloads 0
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