Effect of Target Lesion Revascularization on Restenosis Lesions of the Superficial Femoral Artery without Recurred Symptoms after Endovascular Therapy

Abstract

This study aims to elucidate the effects of early application of target lesion revascularization (TLR) to restenosis lesions of the superficial femoral artery (SFA) without recurrence of symptoms. Despite recent improvements in endovascular therapy (EVT) for the SFA, restenosis remains to be a problem. However, restenosis is not always associated with the recurrence of limb symptoms. Although early application of TLR is not generally approved for restenosis lesions of the SFA without recurred symptoms, it is expected to contribute to longterm patency and other favorable outcomes. Nonetheless, its effectiveness remains to be determined. Methods:We retrospectively analyzed 616 patients who developed restenosis after undergoing femoro-popliteal EVT for claudication (Rutherford category 1 to 3) due to de novo femoro-popliteal lesions between January 2010 and December 2016 at 11 centers in Japan. Recurred symptoms were defined as symptoms of the same or higher Rutherford categories than those immediately before the initial EVT.Results: Of the patients, 291 (47 %) lacked recurred symptoms; 69 (24 %) underwent TLR for restenosis. After propensity matching, the risk of occlusion was determined to be not significantly different between the TLR and observation groups; the 3-year occlusion-free rate was 68 % and 62 %, respectively (P 0.84). The risk of recurring symptoms, critical limb ischemia, and all-cause death was also found to be comparable between groups. The incidence of target vessel revascularization was significantly higher in the TLR than in the observation group (1.55 [95 % confidence interval: 1.25-1.93] vs. 0.59 [0.41-0.85] per 3 person-years). Conclusions:In patients with SFA restenosis without recurred symptoms, early application of TLR showed no advantages.

Association of Age with Mortality Rate after Femoropopliteal Endovascular Therapy for Intermittent Claudication

“…As summarized in Table 2, the 3-year mortality risk increased with age in overall patients with intermittent claudication, from 6.4% (3.6% to 9.4%) for the subgroups aged 65 years to 21.2% (13.6% to 29.1%) for those aged ≥ 85 years. On the contrary, when compared with the year-and sex-adjusted Endovascular therapy for peripheral artery disease has been widely spread in recent years [14][15][16][17][18][19][20][21][22] . In the aging societies, it has become common to perform endovascular therapy in older patients for intermittent claudication in clinical practice.…”

Long-term clinical outcomes of Chinese diabetic patients after coronary revascularization with drug-eluting stents: a retrospective comparative cohort study

“…ISR was defined as stenosis of at least 50% of the minimal luminal diameter in the target lesion at the followup coronary angiography (13). TLR was defined as any symptom driven coronary artery bypass graft or repeat PCI (balloon angioplasty or repeat stent implantation) for ISR, or the occlusion of the target lesion (14). ST was classified using the Academic Research Consortium (ARC) definition (15).…”