05.12.2016 | Clinical Investigation | Ausgabe 3/2017 Open Access

Peripheral Stent Thrombosis Leading to Acute Limb Ischemia and Major Amputation: Incidence and Risk Factors in the Aortoiliac and Femoropopliteal Arteries

Zeitschrift:: CardioVascular and Interventional Radiology > Ausgabe 3/2017

Autoren:: Konstantinos Katsanos, Said A. M. Al-Lamki, Aneeta Parthipun, Stavros Spiliopoulos, Sanjay Dhanji Patel, Ioannis Paraskevopoulos, Hany Zayed, Athanasios Diamantopoulos

» Zum Volltext PDF-Version jetzt herunterladen

Abstract

Purpose

To report the real-world incidence and risk factors of stent thrombosis in the aortoiliac and femoropopliteal arteries in case of bare nitinol stent (BNS) or covered nitinol stent (CNS) placement from a single-centre retrospective audit.

Materials and Methods

Medical records of consecutive patients treated with peripheral stent placement for claudication or critical limb ischemia were audited for definite stent thrombosis defined as imaging confirmed stent thrombosis that presented as acute limb-threatening ischemia. Cases were stratified between aortoiliac and femoropopliteal anatomy. Cox regression analysis was employed to adjust for baseline clinical and procedural confounders and identify predictors of stent thrombosis and major limb loss.

Results

256 patients (n = 277 limbs) were analysed over a 5-year period (2009–2014) including 117 aortoiliac stents (34 CNS; 12.8 ± 5.0 cm and 83 BNS; 7.8 ± 4.0 cm) and 160 femoropopliteal ones (60 CNS; 21.1 ± 11.0 cm and 100 BNS; 17.5 ± 11.9 cm). Median follow-up was 1 year. Overall stent thrombosis rate was 6.1% (17/277) after a median of 43 days (range 2–192 days) and affected almost exclusively the femoropopliteal segment (12/60 in the CNS cohort vs. 4/100 in the BNS; p = 0.001). Annualized stent thrombosis rates (per 100 person-years) were 12.5% in case of CNS and 1.4% in case of BNS (HR 6.3, 95% CI 2.4–17.9; p = 0.0002). Corresponding major amputations rates were 8.7 and 2.5%, respectively (HR 4.5, 95% CI 2.7–27.9; p = 0.0006). On multivariable analysis, critical leg ischemia and CNS placement were the only predictors of stent thrombosis. Diabetes, critical leg ischemia, femoropopliteal anatomy, long stents and CNS were independent predictors of major amputations.

Conclusions

Placement of long femoropopliteal covered nitinol stents is associated with an increased incidence of acute stent thrombosis and ensuing major amputation. Risks are significantly lower in the aortoiliac vessels and with use of bare nitinol stents.

Unsere Produktempfehlungen

e.Med Interdisziplinär

Kombi-Abonnement

Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Premium-Inhalten der Fachzeitschriften, inklusive eines Print-Abos.

Jetzt testen ¹

e.Med Innere Medizin

Kombi-Abonnement

Mit e.Med Innere Medizin erhalten Sie Zugang zu CME-Fortbildungen des Fachgebietes Innere Medizin, den Premium-Inhalten der internistischen Fachzeitschriften, inklusive einer gedruckten internistischen Zeitschrift Ihrer Wahl.

Jetzt testen ²

e.Med Radiologie

Kombi-Abonnement

Mit e.Med Radiologie erhalten Sie Zugang zu CME-Fortbildungen des Fachgebietes Radiologie, den Premium-Inhalten der radiologischen Fachzeitschriften, inklusive einer gedruckten Radiologie-Zeitschrift Ihrer Wahl.

Jetzt testen ³

Fowkes FG, Rudan D, Rudan I, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382(9901):1329–40. CrossRefPubMed

Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA Guidelines for the Management of Patients with Peripheral Arterial Disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Associations for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease)–summary of recommendations. J Vasc Interv Radiol. 2006;17(9):1383–97 quiz 1398. CrossRefPubMed

Moysidis T, Opdenplatz D, Kulendik V, et al. Percutaneous endovascular treatment of peripheral arterial disease in Germany. Cardiovasc Revasc Med. 2015;16(5):290–3. CrossRefPubMed

White CJ, Gray WA. Endovascular therapies for peripheral arterial disease: an evidence-based review. Circulation. 2007;116(19):2203–15. CrossRefPubMed

Pastromas G, Katsanos K, Krokidis M, Karnabatidis D, Spiliopoulos S. Emerging stent and balloon technologies in the femoropopliteal arteries. Sci World J. 2014;2014:695402. CrossRef

Diamantopoulos A, Katsanos K. Treating femoropopliteal disease: established and emerging technologies. Semin Interv Radiol. 2014;31(4):345–52. CrossRef

Katsanos K, Spiliopoulos S, Karunanithy N, Krokidis M, Sabharwal T, Taylor P. Bayesian network meta-analysis of nitinol stents, covered stents, drug-eluting stents, and drug-coated balloons in the femoropopliteal artery. J Vasc Surg. 2014;59(4):1123–33 e1128. CrossRefPubMed

Katsanos K, Tepe G, Tsetis D, Fanelli F. Standards of practice for superficial femoral and popliteal artery angioplasty and stenting. Cardiovasc Interv Radiol. 2014;37(3):592–603. CrossRef

Spiliopoulos S, Theodosiadou V, Fragkos G, et al. Feasibility of endovascular recanalization of occluded infrapopliteal drug-eluting stents. J Endovasc Ther. 2014;21(3):392–9. CrossRefPubMed

10.

Vartanian SM, Johnston PC, Walker JP, et al. Clinical consequence of bare metal stent and stent graft failure in femoropopliteal occlusive disease. J Vasc Surg. 2013;58(6):1525–31. CrossRefPubMed

11.

Holmes DR Jr, Kereiakes DJ, Garg S, et al. Stent thrombosis. J Am Coll Cardiol. 2010;56(17):1357–65. CrossRefPubMed

12.

Siablis D, Karnabatidis D, Katsanos K, et al. Infrapopliteal application of sirolimus-eluting versus bare metal stents for critical limb ischemia: analysis of long-term angiographic and clinical outcome. J Vasc Interv Radiol. 2009;20(9):1141–50. CrossRefPubMed

13.

Luscher TF, Steffel J, Eberli FR, et al. Drug-eluting stent and coronary thrombosis: biological mechanisms and clinical implications. Circulation. 2007;115(8):1051–8. CrossRefPubMed

14.

Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45(Suppl S):S5–67. CrossRefPubMed

15.

Sacks D, Marinelli DL, Martin LG, Spies JB, Society of Interventional Radiology Technology Assessment C. Reporting standards for clinical evaluation of new peripheral arterial revascularization devices. J Vasc Interv Radiol. 2003;14(9 Pt 2):S395–404. CrossRefPubMed

16.

Katsanos K, Spiliopoulos S, Saha P, et al. Comparative efficacy and safety of different antiplatelet agents for prevention of major cardiovascular events and leg amputations in patients with peripheral arterial disease: a systematic review and network meta-analysis. PLoS ONE. 2015;10(8):e0135692. CrossRefPubMedPubMedCentral

17.

Spiliopoulos S, Pastromas G, Katsanos K, Kitrou P, Karnabatidis D, Siablis D. Platelet responsiveness to clopidogrel treatment after peripheral endovascular procedures: the PRECLOP study: clinical impact and optimal cutoff value of on-treatment high platelet reactivity. J Am Coll Cardiol. 2013;61(24):2428–34. CrossRefPubMed

18.

Spiliopoulos S, Kassimis G, Hatzidakis A, Krokidis M. High on-treatment platelet reactivity in peripheral endovascular procedures. Cardiovasc Intervent Radiol. 2014;37(3):559–71. CrossRefPubMed

19.

Golchehr B, Lensvelt MM, Fritschy WM, et al. Outcome of thrombolysis and thrombectomy for thrombosed endografts inserted in the superficial femoral artery for occlusive disease. J Endovasc Ther. 2013;20(6):836–43. CrossRefPubMed

20.

McQuade K, Gable D, Pearl G, Theune B, Black S. Four-year randomized prospective comparison of percutaneous ePTFE/nitinol self-expanding stent graft versus prosthetic femoral-popliteal bypass in the treatment of superficial femoral artery occlusive disease. J Vasc Surg. 2010;52(3):584–90 discussion 590–581, 591 e581–591 e587. CrossRefPubMed

21.

Lammer J, Zeller T, Hausegger KA, et al. Sustained benefit at 2 years for covered stents versus bare-metal stents in long SFA lesions: the VIASTAR trial. Cardiovasc Interv Radiol. 2015;38(1):25–32. CrossRef

22.

Lammer J, Zeller T, Hausegger KA, et al. Heparin-bonded covered stents versus bare-metal stents for complex femoropopliteal artery lesions: the randomized VIASTAR trial (Viabahn endoprosthesis with PROPATEN bioactive surface [VIA] versus bare nitinol stent in the treatment of long lesions in superficial femoral artery occlusive disease). J Am Coll Cardiol. 2013;62(15):1320–7. CrossRefPubMed

23.

Saxon RR, Chervu A, Jones PA, et al. Heparin-bonded, expanded polytetrafluoroethylene-lined stent graft in the treatment of femoropopliteal artery disease: 1-year results of the VIPER (Viabahn Endoprosthesis with Heparin Bioactive Surface in the Treatment of Superficial Femoral Artery Obstructive Disease) trial. J Vasc Interv Radiol. 2013;24(2):165–73. CrossRefPubMed

24.

Iida O, Takahara M, Soga Y, et al. 1-year results of the ZEPHYR Registry (Zilver PTX for the Femoral Artery and Proximal Popliteal Artery): predictors of Restenosis. JACC Cardiovasc Interv. 2015;8(8):1105–12. CrossRefPubMed

25.

Krankenberg H, Tubler T, Sixt S, et al. German multicenter real-world registry of stenting for superficial femoral artery disease: clinical results and predictive factors for revascularization. J Endovasc Ther. 2014;21(4):463–71. CrossRefPubMed

26.

Sartori M, Conti E, Favaretto E, Frascaro M, Legnani C, Palareti G. Thrombotic risk factors and cardiovascular events after endovascular intervention for peripheral arterial disease. Eur J Vasc Endovasc Surg. 2011;42(6):817–23. CrossRefPubMed

27.

Conrad MF, Crawford RS, Hackney LA, et al. Endovascular management of patients with critical limb ischemia. J Vasc Surg. 2011;53(4):1020–5. CrossRefPubMed

28.

Banerjee S, Sarode K, Mohammad A, et al. Femoropopliteal artery stent thrombosis: report from the excellence in peripheral artery disease registry. Circ Cardiovasc Interv. 2015;9(2):e002730. CrossRef

Titel: Peripheral Stent Thrombosis Leading to Acute Limb Ischemia and Major Amputation: Incidence and Risk Factors in the Aortoiliac and Femoropopliteal Arteries
Autoren:: Konstantinos Katsanos
Said A. M. Al-Lamki
Aneeta Parthipun
Stavros Spiliopoulos
Sanjay Dhanji Patel
Ioannis Paraskevopoulos
Hany Zayed
Athanasios Diamantopoulos
Publikationsdatum: 05.12.2016
DOI: https://doi.org/10.1007/s00270-016-1513-0
Verlag: Springer US
Zeitschrift: CardioVascular and Interventional Radiology
Ausgabe 3/2017
Print ISSN: 0174-1551
Elektronische ISSN: 1432-086X

Neu im Fachgebiet Radiologie

17.07.2018 | Klinik aktuell | Nachrichten | Onlineartikel

Peripheral Stent Thrombosis Leading to Acute Limb Ischemia and Major Amputation: Incidence and Risk Factors in the Aortoiliac and Femoropopliteal Arteries

Abstract

Purpose

Materials and Methods

Results

Conclusions

Unsere Produktempfehlungen

e.Med Interdisziplinär

e.Med Innere Medizin

e.Med Radiologie

Streit um "Strafgebühr" im Krankenhaus

MRT-Studie: Weg mit der Krawatte vom Männerhals!

Wie hoch ist der Preis des Screenings auf Brustkrebs?

MRT-Truck kommt aufs Land

Medizinische Fremdkörper in der Bildgebung

Atlas Klinische Neuroradiologie des Gehirns

Newsletter

Springer Medizin

Abstract

Purpose

Materials and Methods

Results

Conclusions

Unsere Produktempfehlungen

e.Med Interdisziplinär

e.Med Innere Medizin

e.Med Radiologie

Weitere Artikel der Ausgabe 3/2017

Chemoembolization of Neuroendocrine Liver Metastases Using Streptozocin and Tris-acryl Microspheres: Embozar (EMBOsphere + ZAnosaR) Study

Robotic-Assisted Versus Manual Prostatic Arterial Embolization for Benign Prostatic Hyperplasia: A Comparative Analysis

Bridging Locoregional Therapy Prolongs Survival in Patients Listed for Liver Transplant with Hepatocellular Carcinoma

A Novel Method of Adrenal Venous Sampling via an Antecubital Approach

Radiofrequency Ablation of Hepatocellular Carcinoma with a “Nodule-in-Nodule” Appearance: Long-Term Follow-up and Clinical Implications

Reply to the Comment: Prophylactic Uterine Artery Embolization in Mid-trimester Pregnancy Termination for Placenta Previa: Required for all Patients?

Neu im Fachgebiet Radiologie

Streit um "Strafgebühr" im Krankenhaus

MRT-Studie: Weg mit der Krawatte vom Männerhals!

Wie hoch ist der Preis des Screenings auf Brustkrebs?

MRT-Truck kommt aufs Land

Meistgelesene Bücher aus der Radiologie

Medizinische Fremdkörper in der Bildgebung

Atlas Klinische Neuroradiologie des Gehirns

Newsletter