PS138. Surgical Implications of Failed Stenting of the Superficial Femoral Artery

The purpose of this study was to determine if failed stent placement in the superficial femoral artery influences future open bypass options. Between January 1, 1998 and February 29, 2009, 1216 endovascular interventions were performed in the femoral or popliteal arteries. A prospective analysis of pre and post-intervention angiograms was performed to determine the optimal distal bypass targets and Rutherford tibial runoff scores. Of 204 patients with failed endovascular intervention, angiographic records were available for 64 patients (39 stent, 25 angioplasty). The median patient age was 64, 53% were male, and 57% had Diabetes. The indication for intervention was claudication in 32%, rest pain in 24% and tissue loss in 44%. One stent was used in the majority of cases (76%) with a median stent length of 96 mm (40 mm with those receiving one stent). Indications for stent placement included residual stenosis in 22 (56%), dissection in 7 (18%) and elastic recoil in 5 (13%). Median time to failure was 203 days. The distal bypass target changed for 9 patients (23%) in the stent arm and 7 patients (33%) in the angioplasty arm. Median pre and post-intervention runoff scores remain unchanged in both groups (6.3 and 6.7). The only factor implicated in worsening bypass targets was poor tibial runoff pre-procedure. Early failure of endovascular treatment of the superficial femoral artery rarely alters the distal target if open bypass is planned. Stenting does not influence tibial runoff or increase the likelihood of necessitating a more distal bypass over angioplasty alone. Poor tibial runoff is a risk factor for loss of above knee bypass targets if endovascular intervention fails.