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Biomedical subjects

Stephen W K Cheng

Publications and source records attributed to Stephen W K Cheng.

At least 19 recordsLinked to original sources
PubMed2006

Carotid intima-media thickness in patients with abdominal aortic aneurysms.

OBJECTIVE: The contribution of atherosclerosis to the development of Abdominal Aortic Aneurysms (AAA) is still controversial. Ultrasound scans can detect intima-media thickening of the carotid arteries as an early sign of atherosclerosis. The aim of this study was to investigate whether patients with Abdominal Aortic Aneurysms (AAAs) have thickened carotid IMT as patients with atherosclerotic peripheral arterial disease (PAD). METHODS: With high-resolution B-mode ultrasonography, the intima-media thickness (IMT) in the carotid arteries (right and left common carotid artery) was measured in AAA patients and compared with that of age and sex-matched patients with atherosclerotic peripheral arterial disease (PAD). A third group of healthy age and sex- matched control subjects were included for comparison. The corresponding carotid artery lumen was also determined in all groups. Comparison of the three groups was made by ANOVA. RESULTS: Fifty-eight AAA patients and 69% were men (mean age of 72.3 years) were studied. Aged and sex-matched groups comprised of 111 PAD patients and 71 healthy. The mean carotid IMT was highest in PAD patients (1.036+/-0.18mm). The values of controls and AAA patients were similar and significantly lower than that of atherosclerotic patients (0.875+/-0.11mm and 0.812+/-0.53mm respectively, both p<0.005 vs. PAD). Narrowing of the corresponding lumen was found in PAD patients compared with that of AAA patients, but no difference can be seen between healthy subjects and AAA patients. The mean carotid IMT was greater in men (P<0.05) in all studied groups, but no similar gender specificity was found in the lumen diameter. CONCLUSIONS: This study shows that the carotid artery IMT of AAA patients is similar to healthy subjects, but not as thick as patients with atherosclerotic disease. As carotid (IMT) is a surrogate marker of atherosclerosis, the findings support the notion that the formation of AAA may not be fully atherosclerosis-dependent. Gender may be a confounding factor for carotid intima-media thickening.

Adult↗
PubMed2006

Endovascular stent graft repair for infected thoracic aortic pseudoaneurysms--a durable option?

OBJECTIVE: Open surgical repair for infected thoracic aortic pseudoaneurysms carries significant mortality and morbidity. Endovascular stent graft repair has been our preferred approach, although its role remains controversial because persistent infection is always a concern. We aimed to assess the efficacy and durability of endovascular stent graft repair in these patients. METHODS: Between August 2000 and November 2005, seven consecutive patients with eight infected pseudoaneurysms of the thoracic aorta were treated with endovascular stent graft repair. Patients were diagnosed based on a typical appearance of an infected pseudoaneurysm on imaging together with a positive bacteriology culture or clinical evidence of sepsis. The follow-up protocol included regular clinical examination, hematologic tests, and computed tomography scans. RESULTS: There were six men and one woman with a median age of 68 years at operation. Three patients presented with an aortoenteric fistula. The operations were performed in the operating room with the image guidance of a mobile C-arm. Endovascular stent grafts were deployed successfully in all patients, with complete exclusion of the pseudoaneurysms. Intravenous antibiotics were continued for 1 to 6 weeks and followed by lifelong maintenance oral antibiotics. The median hospital stay was 27 days, with no hospital deaths. No paraplegia or other major complications occurred. Two patients with aortoesophageal fistula where the fistula tracts were persistent died during follow-up. The other five patients remained well, with no evidence of graft infection at a median follow-up of 34 months. A significant reduction in the diameter of the pseudoaneurysm (>5 mm) was noted on computed tomography scans after 12 months. CONCLUSION: Endovascular stent graft repair is effective and may be a durable option for infected pseudoaneurysms of the thoracic aorta.

Adult↗
PubMed2006

Improvement of mortality of ruptured abdominal aortic aneurysm patients over 12 years and its relationship with tracheostomy.

Cardiopulmonary complication after ruptured abdominal aortic aneurysm (rAAA) repair is an important cause of mortality. Early tracheostomy promotes patient recovery from respiratory morbidities. A policy of routine immediate tracheostomy was adopted in 1999 at our institution. This study investigates the trend of hospital mortality of rAAA patients over 12 years with particular reference to immediate tracheostomy. Consecutive rAAA patients operated during 1993-2004 were divided into two groups (first group, 1993-1998; second group, 1999-2002). Intra- and postoperative care was the same for all patients except that immediate tracheostomy was performed routinely in the second group and only selectively in the first. Hospital mortality of the two groups was examined. Patient characteristics, biochemical parameters, aneurysm feature, operative details, and clinical outcomes of the two groups (excluding 48 hr perioperative mortalities) were compared to identify prognostic factors of hospital mortality. Sixty-three patients were operated during the study period. The overall hospital mortality for the first and second groups was 62.5% (20/32) and 22.6% (7/31) (p=0.001), respectively. Excluding the 48 hr mortalities, 57.1% (12, n=21) of patients in the first group and 85.7% (24, n=28) of those in the second group survived to be discharged from hospital (p=0.048). The pre-, intra-, and postoperative parameters were comparable between the two groups. Immediate tracheostomy was performed for all patients in the second group and only 52.4% (11) in the first group. Male gender, high creatinine level on presentation, postoperation cardiac morbidity, renal failure, and bowel ischemia were found to be associated with a higher mortality. Immediate tracheostomy is a significant factor associated with improved survival. In conclusion, a significant improvement of rAAA patients' in-hospital mortality was achieved during the study period. Tracheostomy performed immediately following rAAA repair is associated with better hospital survival.

Aortic Aneurysm, Abdominal↗
PubMed2006

Reduction in deep vein reflux after concomitant subfascial endoscopic perforating vein surgery and superficial vein ablation in advanced primary chronic venous insufficiency.

BACKGROUND: Subfascial endoscopic perforating vein surgery (SEPS) and superficial vein surgery (SVS) have been the recommended treatment for advanced chronic venous insufficiency (CVI), despite a high prevalence of deep vein reflux in these patients. The anatomic and hemodynamic results of these procedures, however, remain uncertain. It is hypothesized that concomitant SEPS and SVS would result in a reduction of deep vein reflux in patients with advanced primary CVI. We investigated the effect of concomitant SEPS and SVS on deep vein reflux as well as the associated hemodynamic and clinical changes after surgery in a cohort of patients with advanced primary CVI. METHODS: We prospectively evaluated 53 consecutive SEPSs with concomitant SVS procedures in 47 patients with advanced primary CVI. There were 25 men and 22 women with a mean age of 58 years at operation. Thirty-four procedures (64%) were performed for limbs with active venous ulcers (class 6), and the other 19 procedures were performed for 15 class 5 limbs, one class 4a limb, and three class 4b limbs, respectively. Duplex scan and air plethysmography were performed before operation, at 1 month, and at 1 year after operation. The patients were followed up regularly with clinical assessment, and the ulcer healing and recurrence rates were documented. RESULTS: The proportion of limbs with common femoral vein incompetence decreased from 68% to 28% at 1 month and to 32% at 1 year after operation. The proportion of limbs with deep vein incompetence at more than one site also decreased from 42% to 15% at 1 month and to 12% at 1 year after concomitant SEPS and SVS. Venous hemodynamics as measured by air plethysmography improved significantly after operation. The cumulative ulcer healing was 85% at 3 months and 97% at 6 months. With a mean follow-up of 31 +/- 16 months, all ulcers healed. Only three recurrent ulcers (6%) were detected during the follow-up period. CONCLUSION: Concomitant SEPS and SVS are effective in reducing deep vein reflux and results in hemodynamic and clinical improvements in patients with advanced primary CVI. Deep vein reconstruction procedures may not be necessary in these patients.

Adult↗
PubMed2006

Vascular smooth muscle cell apoptosis induced by "supercooling" and rewarming.

PURPOSE: The underlying mechanisms for the reduction in restenosis caused by cryoplasty for peripheral atherosclerotic lesions are not well understood. Because vascular smooth muscle cells (SMCs) are known to play a critical role in restenosis and neointimal hyperplasia, the aim of this study was to determine SMC survival under conditions of "supercooling" and/or rewarming. MATERIALS AND METHODS: Bovine aortic SMCs were supercooled to -10 degrees C for 0, 60, or 120 seconds with a custom-designed conduction cooling stage and then rewarmed to 37 degrees C in an incubator for 0, 12, or 24 hours. A terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling assay was used to measure the degree of apoptosis. Activation of Akt (ie, protein kinase B), a key signal protein involved in cell survival, was assessed by Western blot analysis. RESULTS: An increase in apoptotic SMCs was observed with increasing supercooling and rewarming time. Akt was significantly activated at only the most severe condition (120 seconds of supercooling and 24 hours of rewarming), which showed a 2.03-fold increase compared with the group without rewarming. CONCLUSIONS: The data suggest that SMC apoptosis occurs with supercooling and rewarming. Protective cell survival mechanisms were activated only late in the rewarming phase. This may partially explain the long-term patency observed with cryoplasty of atherosclerotic peripheral lesions.

Analysis of Variance↗
PubMed2005

Plasma fibrinogen level: an independent risk factor for long-term survival in Chinese patients with peripheral artery disease?

Fibrinogen, an inflammatory marker as well as a fundamental part of the coagulation cascade, is suggested to play a significant role in the pathogenesis of atherosclerosis and complications of atherothrombotic diseases. The aim of this study was to determine if plasma fibrinogen is an independent risk factor for long-term survival in patients with peripheral artery disease (PAD). Altogether, 139 Chinese patients (88 men, 51 women) with PAD were consecutively recruited for the study. Atherothrombotic risk factors and fibrinogen levels were determined at presentation, and all patients were followed up for mortality prospectively. The mean follow-up was 6 years. All variables were first correlated with survival rates using Kaplan-Meier analysis and compared by means of the log-rank test. Significant risk factors were identified, and multivariate Cox regression analysis was used to evaluate the independent contribution of the fibrinogen level to the risk of mortality. During follow-up, 95 patients (68.3%) died. The overall survival rate was 77.7% at 3 years, 56.8% at 5 years, and 31.2% at 10 years (standard errors 0.05, 0.06, and 0.07, respectively). All-cause mortality rate increased with an elevated fibrinogen level. Eighty percent of patients with a fibrinogen level > 3.4 g/L had a survival time of less than 3 years (p = 0.002). This relation was also demonstrated within patients with critical ischemia. The plasma fibrinogen level was thus identified as an independent risk factor for mortality in PAD patients after adjusting for confounding factors.

Aged↗
PubMed2005

Surgical treatment of infected aneurysms and pseudoaneurysms of the thoracic and abdominal aorta.

BACKGROUND: To review the outcome of infected aneurysms and pseudoaneurysms of the thoracic and abdominal aorta treated in a major teaching hospital. METHODS: Between December 1994 and January 2003, 13 infected aortic aneurysms and pseudoaneurysms (5 thoracic, 4 paravisceral, 4 infrarenal) in 10 consecutive patients were treated surgically. Aortic debridement with in situ reconstruction is our standard practice. Endovascular repair was offered to suitable patients with thoracic aortic involvement. RESULTS: There were six men and four women with a mean age of 63 years. The commonest pathogen was Salmonella species, accounting for 50% of the cases. Aortic debridement with in situ revascularization was performed for six patients with visceral reconstruction in four of them. One patient with aortic bifurcation involvement and gross purulent infection had ligation and debridement followed by right axillobifemoral bypass. Four infected thoracic aortic pseudoaneurysms in three other patients underwent endovascular repair. There was no hospital death, limb loss, renal failure, or intestinal ischemia. There were two late deaths from sepsis and pneumonia at 3 months and 77 months after operation. Eight patients were alive after a mean follow-up of 36 months and no late graft infection was evident. CONCLUSIONS: Surgical treatment for infected aortic aneurysms with in situ reconstruction is associated with favorable outcome and good long-term result. Endovascular repair has a potential role.

Adult↗
PubMed2004

Differential expression of integrin alpha5beta1 in human abdominal aortic aneurysm and healthy aortic tissues and its significance in pathogenesis.

BACKGROUND: Abdominal aortic aneurysm (AAA) is a common aged disease of human aorta with increasing incidence. It is characterized by dramatic vascular remodeling via proteolysis and degradation of matrix proteins. Integrins are important cellular receptors for matrix proteins, which may have an association with pathological remodeling. The present study was undertaken to analyze the expression of integrin subunits in human aneurysmal aortas and with healthy aortic tissues as controls. MATERIALS AND METHODS: The expression of integrin genes in AAA specimens and healthy human aortic tissues was detected by RT-PCR technique. The correlation of variation and distribution of smooth muscle cells (SMCs) and integrin protein expression in the corresponding tissues were studied immunohistochemically. RESULTS: The gene transcripts coding for integrin alpha4, alpha5, alphaV, beta1, beta3, beta5, and beta6 subunits were constitutively expressed in the normal aortas. Only gene expressions of integrin alpha5 and beta1 were significantly decreased by 81% and 85%, respectively, in AAA specimens (P < 0.005) when compared with healthy aortic specimens. No age dependence of the expression of integrin alpha5beta1 genes was found. Significant reduction of medial SMC density was confirmed in corresponding AAA compared with control aortas. Immunoreactivity of integrin alpha5beta1 receptor was found to be exclusively localized within the medial layer of the parallel normal aortic sections, whereas this protein was absent in the destructive media of aneurysmal aortic sections. CONCLUSIONS: The marked decrease in integrin alpha5beta1 expressions was unique to aneurysmal aortic tissues and correlated to a decrease in density of SMCs, which are the major cells in maintaining the structure stability of normal aortas. As integrin alpha5beta1 specifically binds fibronectin and collagen, those results may suggest that the absence of integrin alpha5beta1 activity impair matrix protein attachment and alter the architecture in aortic media thereby lead to the deformity of aorta and aneurysm formation.

Adult↗
PubMed2004

Endovascular repair for multiple Salmonella mycotic aneurysms of the thoracic aorta presenting with Cardiovocal syndrome.

Salmonella mycotic thoracic aortic aneurysm is a rare but life-threatening condition. We report a 59-year-old man with two Salmonella mycotic thoracic aortic aneurysms, presented with fever and chills associated with hoarseness due to left vocal cord palsy (Cardiovocal syndrome). Successful endovascular repair was performed using two Talent thoracic stent-graft devices deployed separately to cover the two mycotic aneurysms. Subsequent computed tomography at 12 months after the operation confirmed exclusion of the two pseudoaneurysms with no endoleak. With potent antibiotics and careful surveillance program, endovascular repair is a possible alternative to conventional open surgery in the management of mycotic thoracic aortic aneurysms, especially in high-risk patients.

Aneurysm, Infected↗
PubMed2004

Accelerated progression of carotid stenosis in patients with previous external neck irradiation.

OBJECTIVE: Radiotherapy to the head and neck often results in carotid stenosis, but the course of disease is unknown. We investigated the natural history and progression of asymptomatic carotid stenosis induced by external irradiation. Patients and methods The study included 130 carotid arteries in 95 patients who had received external radiation therapy to the head and neck area and who had asymptomatic, mild internal carotid artery or common carotid artery stenosis. Stenosis of 15% to 49% on duplex ultrasound (US) scans defined mild (<50%) disease. Another 95 arteries in 74 patients with matched degree of carotid artery stenosis but who had not received radiation therapy were used as control. Both groups were followed up prospectively with serial duplex US scanning, and degree of carotid artery stenosis was categorized as 15% to 49%, 50% to 69%, 70% to 99%, and occlusion. Progression of carotid artery stenosis was defined as increase in stenosis from less than 50% to 50% or greater at ultrasonography. Secondary end points included progression to higher disease category, new cerebrovascular symptoms, and death. Data from irradiated arteries was compared with control data with the life table method. A Cox regression model was used to analyze disease progression, adjusted for covariates of sex, age, smoking, diabetes, and hypertension. RESULTS: Mean follow-up was 36 months. Adjusted freedom from progression rates at 3 years were 65% for irradiated arteries and 87% for control arteries at life-table analysis (P =.035; odds ratio, 3.1). The annualized progression rate from less than 50% to 50% or greater in irradiated arteries was 15.4%, compared with 4.8% in nonirradiated arteries. A long history of cervical irradiation (>6 years) was the only significant risk factor for disease progression. There was no difference between the two groups regarding development of new symptoms or mortality. CONCLUSIONS: Carotid stenosis associated with external irradiation progresses more rapidly compared with nonirradiated atherosclerotic arteries. Aggressive surveillance is recommended.

Aged↗
PubMed2004

Combined endovascular stent grafting and endoscopic injection of fibrin sealant for aortoenteric fistula complicating esophagectomy.

A 67-year-old man with previous total gastrectomy and roux-en-Y esophagojejunostomy had hematemesis 4 weeks after esophagectomy performed because of carcinoma of the esophagus. Investigation showed an aortojejunal fistula with a thoracic aortic pseudoaneurysm. Endovascular stent grafting of the pseudoaneurysm, followed by endoscopic injection of fibrin sealant for the fistula, was performed, and the infection was controlled with broad-spectrum antibiotic agents together with drainage and daily irrigation of the pseudoaneurysm sac. The fistula subsequently healed. The patient remained well 14 months after the procedure; follow-up computed tomograms at 12 months did not show any pseudoaneurysm, and there was no evidence of reopening of the fistula.

Aged↗
PubMed2004

Blood loss and transfusion in elective abdominal aortic aneurysm surgery.

BACKGROUND: Intraoperative blood loss and transfusion are known determinants of mortality and morbidity of elective abdominal aortic aneurysm (AAA) repair. The present study analysed the pattern of blood loss and transfusion and evaluated the risk factors of blood loss during open repair of infrarenal AAA. METHODS: Blood loss, transfusion and fluid replacement during elective open repair operation for patients with infrarenal AAA were correlated to demographic data, operative findings and procedural information. RESULTS: A total of 129 patients with a mean age of 71 years was analysed. The mean blood loss was 1000 +/- 887 mL (200-6000 mL). Blood transfusion, with a mean transfusion volume of 400 +/- 591 mL (0-3000 mL), was required in 46% of patients. Univariate analysis showed that bodyweight, renal impairment, low haemoglobin and platelet counts, iliac artery involvement, large aneurysm, bifurcated graft, large graft diameter, prolonged aortic clamp time and long operation time were associated with a higher blood loss. A haemoglobin level of <10.5 g/dL (relative risk (RR): 4.6), platelet count <130 x 10(9)/L (RR: 3.9), aortic clamp time >50 min (RR: 15), total operation time >200 min (RR: 11) and type of graft (RR: 3.5) were identified as independent determinants of blood loss on multivariate analysis. CONCLUSION: Intraoperative blood loss in elective infrarenal aneurysm surgery is influenced by patients' haematological parameters, distal involvement of aneurysm and degree of difficulty of operation.

Aged↗
PubMed2004

Carotid stenting for radiation-induced extracranial carotid artery occlusive disease: efficacy and midterm outcomes.

PURPOSE: To investigate the immediate and midterm results of carotid stenting for severe radiation-induced extracranial carotid artery disease. METHODS: Between April 1998 and May 2002, 16 patients (15 men; mean age 64 +/- 8 years, range 48-72) presented with 18 severe radiation-induced carotid stenoses in the internal carotid artery (n=3), common carotid artery (n=7), and both vessels (n=8). Thirteen (76%) patients were symptomatic; the mean degree of carotid stenosis was 85% +/- 10% (range 70%-95%). An independent neurological specialist assessed perioperative neurological complications before and after treatment. The patients were followed prospectively for at least 12 months by clinical examination and serial duplex ultrasound scanning. Restenosis was defined as a diameter reduction >50%. RESULTS: Of 18 stent procedures attempted (2 staged), 1 was abandoned owing to failure to pass the guidewire across a tight lesion (94% technical success by intent to treat). In the 17 successfully completed procedures, 17 Wallstents and 4 SMART stents were deployed with satisfactory anatomical results. One postoperative stroke occurred as a result of thromboembolism to the ipsilateral middle cerebral artery and led to hospital death (5.9% combined stroke and death rate). One transient ischemic attack occurred (11.6% neurological event rate). With a median 30-month follow-up (range 5-55), 3 (17.6%) recurrent stenoses (>50%) were detected on duplex scan; 1 repeat angioplasty was performed. No new neurological event has been detected. CONCLUSIONS: Carotid stenting may be performed in patients with irradiation-induced carotid stenosis with acceptable risks and midterm durability.

Aged↗
PubMed2004

Aortic aneurysm morphology in Asians: features affecting stent-graft application and design.

PURPOSE: To determine the morphological features of abdominal aortic aneurysms (AAA) in an Asian cohort in order to identify unique features relevant to stent-graft planning and application. METHODS: Spiral computed tomography (CT) and angiographic assessment of AAA morphology was performed on 65 ethnic Chinese (58 men; mean age 74 years, range 50-87) who underwent endovascular AAA repair. Morphological parameters were compared with published data from American and European patients. The eligibility and potential concerns referable to 4 current stent-graft designs were addressed. RESULTS: Both common iliac arteries (CIA) measured significantly shorter in Asians, particularly on the right side. The mean RCIA and LCIA lengths were 29.9 mm and 34.2 mm, respectively (25.7 and 34.1 mm for CIAs <20 mm in diameter), compared to >50-mm in Caucasians (p<0.001). The distance between the lowest renal artery and the CIA bifurcation averaged 20 mm shorter in Asians: 148 mm on the right side and 153 mm for the left. The CIAs were also wider, averaging 20.2 mm for the right and 17.9 mm for the left. Other linear measurements did not show a population difference. The AAAs in this series were slightly larger (p<0.001), with a shorter neck (mean 23 mm, p<0.001). No correlation was found between the morphological parameters and body build. Internal iliac artery coverage with or without embolization was necessary in 51% of endovascular repairs due to short or aneurysmal CIAs. CONCLUSIONS: These differences in AAA morphology pose unique challenges for endovascular repair in Asians. Preoperative angiography is more often necessary. The need for an accurate landing in a short CIA and insufficient length for maneuvering placed constraints on 2-piece graft designs with long main body lengths. A 3-piece endograft with wider aortic and iliac diameters is currently the most attractive option.

Aged↗
PubMed2003

Surgical competence.

Recent high-profile cases have heightened the need for a formal structure to monitor achievement and maintenance of surgical competence. Logbooks, morbidity and mortality meetings, videos and direct observation of operations using a checklist, motion analysis devices, and virtual reality simulators are effective tools for teaching and evaluating surgical skills. As the operating theater is also a place for training, there must be protocols and guidelines, including mandatory standards for supervision, to ensure that patient care is not compromised. Patients appreciate frank communication and honesty from surgeons regarding their expertise and level of competence. To ensure that surgical competence is maintained and keeps pace with technologic advances, professional registration bodies have been promoting programs for recertification. They evaluate performance in practice, professional standing, and commitment to ongoing education.

Certification↗
PubMed2003

Epidemiology and outcome of aortic aneurysms in Hong Kong.

The objective of this study was to determine epidemiology and mortality statistics for abdominal aortic aneurysms (AAAs) in Hong Kong. Data from three sources were obtained and analyzed: (1) Hong Kong Hospital Authority discharge statistics for 1999 and 2000; (2) a survey on aortic aneurysms in public hospitals conducted by the Working Group of Vascular Surgery; and (3) the Department of Surgery, University of Hong Kong Medical Center aortic aneurysm database. The disease pattern, distribution, and operative mortality were determined. The annual incidence of AAA in Hong Kong is 13.7 per 100,000 population and 105 per 100,000 for those aged 65 and above. About 10% of the AAAs that presented were ruptured. The mean age of the AAA patients was 74 years, with 84% of them over age 65. The operative repair rate for AAAs was low, being only 8% for intact aneurysms and 54% for ruptured ones. Overall, 45% of all aneurysm repairs were performed for a ruptured AAA. There is diverse practice between major vascular centers and smaller regional hospitals. The territory-wide operative mortality rates for intact and ruptured aneurysms were 10% (range 4-24%) and 70% (range 38--100%), respectively. There was no gender bias in the rupture and operative rates. The overall mortality was 17% for intact AAAs and 78% for ruptured AAAs. The average length of hospital stay was 19 days for elective AAA surgery and 13 days for ruptured AAAs. The number of operations in high-volume centers is increasing with a concomitant decrease in operative mortality. There are no definitive data to indicate that the incidence of AAAs is rising, but a trend toward an increasing number of operations in referral centers is noted. The low repair rates for intact AAAs and the high proportion of repairs for ruptured aneurysms suggest that AAAs are undertreated in Hong Kong.

Aged↗
PubMed2003

Angioplasty and primary stenting of high-grade, long-segment superficial femoral artery disease: is it worthwhile?

The purpose of this study was to determine the long-term results and efficacy of angioplasty and stenting of long-segment, high-grade superficial femoral artery disease. Seventy-three consecutive primary balloon angioplasty procedures with immediate stenting in 70 patients with SVS/ISCVS grade B2 or C superficial femoral artery (SFA) disease exceeding 5 cm in length were evaluated. The mean lesion length was 16 cm and occlusion constituted 62%, with a runoff score of 8. Forty-nine procedures (67%) were performed for critical ischemia. A total of 135 stents were placed. Follow-up was with 3-month duplex ultrasound; stenosis >50% was considered the end point for failure. Mean follow-up time was 26 months. Initial technical success with intent to treat was 90%. Initial success according to anatomic, hemodynamic, and clinical criteria was 90%, 88%, and 88%, respectively, with intent to treat. Limb salvage in the critical ischemia group was 71%. Overall cumulative primary patency rates at 12, 24, and 48 months were 56%, 35%, and 22%, and secondary patency rates were 69%, 47%, and 37%, respectively. A stented segment length >10 cm and procedure in claudicants incurred an inferior patency rate. Treatment of high-grade SFA lesions with angioplasty and primary setting results in lower long-term patency rate than those with surgery, but combined with secondary interventions this treatment option may be an acceptable alternative in selected patients with critical ischemia. Femoropopliteal bypass remains the procedure of choice.

Aged↗