Mid-term outcomes of covered and bare metal stents for femoropopliteal atherosclerotic disease

Abstract

Objective

Endovascular modality used in peripheral vascular intervention (PVI) varies widely. Long-term outcomes are poorly studied between covered stents (CS) and bare metal stents (BMS) for the SFA.

Methods

Patients (2017–2021) undergoing CS and BMS to the SFA were identified at an academic institution. Comparative statistics and Kaplan–Meier analysis were used to evaluate outcomes by group.

Results

One hundred and nineteen patients undergoing stenting were included with 60 patients undergoing CS (50%) and BMS in 59 (50%). There were no differences in sex (p = 0.5), preoperative ABI (p = 0.2) or indication for surgery between groups (p = 0.8). CS patients had undergone more prior SFA interventions (p = 0.03) and were younger (62 vs. 66 years; p = 0.04). Regarding anatomic and operative characteristics, CS patients had more TASC C/D lesions (69 vs. 47%; p = 0.006) less severe calcification (8 vs.17%; p = 0.0006) and more often underwent angioplasty and stenting (90 vs 51%; p < 0.0001) and less often angioplasty, DCB and stenting (5 vs. 43%; p < 0.0001). CS patients had larger SFA (5.7 vs 4; p < .0001), longer lesions (119 vs. 89 mm; p = 0.0008), higher popliteal runoff score (8.3 vs. 6.4; p = 0.02), longer surgery (140 vs. 118 min; p = 0.03), less fluoroscopy time (21 vs. 26 min; p = 0.03), larger SFA stent (6.2 vs. 5.6 mm; p < 0.0001), and longer stented length (260 vs. 171 mm; p < 0.0001). There were no differences in concomitant iliac/tibial treatment between groups (p = 0.3). Regarding outcomes, there were no differences in amputation (CS 10 vs. BMS 10.2%; p = 1) but overall mortality was lower in CS patients (8 vs 22%; p = 0.04) as was acute limb ischemia (17 vs. 34%; p = 0.03). CS patients underwent fewer endovascular (p = 0.03) and open reinterventions (p = 0.005) but a shorter time to first endovascular reintervention (5.6 vs. 17.8 months; p = 0.0002) on unadjusted analysis. Kaplan-Meier estimated survival at 48 months was 83% for CS and 75% for BMS (p = 0.28). At 36 months, primary patency was 35% for CS vs. 41% for BMS (p = 0.09), primary-assisted patency was 57% for CS vs. 68% for BMS (p = 0.04) and secondary patency for CS was 61% vs. 61% for BMS (p = 0.99).

Conclusions

In this series, CS was associated with lower reintervention rates than BMS despite higher TASC classification, longer lesions, and higher popliteal runoff scores. CS was more often used to salvage previous SFA intervention. At 3 years, however, patency was similar between groups. These data suggest some advantages for CS over BMS in endovascular salvage of failed SFA intervention and potentially a preferred modality for more complex SFA lesions than BMS.