Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3876_Библиотеки_им_академика_М_И_Перельмана

DeCarlo etal. [31] sought to determine if patients with failed SFA covered stent (CS) were more likely to present with more severe ischemic symptoms than patients with failed SFA bare metal stent (BMS) in a retrospective review of data from the Vascular Quality Initiative. There were 3721 patients: 3338 with index BMS, 383 with index CS.At reintervention, acute limb ischemia (ALI) was the presenting symptom for 12.0% of the CS cohort vs 6.3% of the BMS cohort (P<.001). More patients with an index CS underwent major amputation at the time of reintervention (2.6% vs 1.0%; P=.006). This study demonstrates that patients with a failed SFA CS are almost twice as likely to present with ALI as patients with a failed SFA BMS.Patients with failed SFA CS are also more likely to present with more severe ischemia, more likely to require an urgent or emergent reintervention, and more likely to undergo an open bypass at the time of representation for failure. Concerns about CS and their use in femoropopliteal occlusive disease have been raised. First, the placement of a CS in the femoropopliteal segment could result in the coverage of important collaterals. Second, the mechanism of failure with these grafts is referred to as edge stenosis. The edge of the stiff CS causes intimal hyperplasia, leading to compromised inow or outow and subsequent stent thrombosis, result­ing in a new, long-segment occlusion. The risks of CS placement should be consid­ered in operative planning and preoperative discussion for SFA stenting.