Endovascular Treatment of Severely Calcified Femoropopliteal Lesions Using the "Pave-and-Crack" Technique: Technical Description and 12-Month Results

• Type: Article in International Scientific Journal
• Date: 2018

Authors

Dias-Neto M (Author) FMUP; Matschuck, M (Author) Other; Bausback, Y (Author) Other; Banning Eichenseher, U (Author) Other; Steiner, S (Author) Other; Branzan, D (Author) Other; Staab, H (Author) Other; Varcoe, RL (Author) Other; Scheinert, D (Author) Other; Schmidt, A (Author) Other

Journal

The Journal is awaiting validation by the Administrative Services.

Title: Journal of Endovascular Therapy

Vol. 25

Pages: 334-342

ISSN: 15266028

Indexing

ISI Web of Knowledge - 35 Citations

Scopus - 36 Citations

Other information

Authenticus ID: P-00R-AB1

DOI: 10.1177/1526602818763352

Abstract (EN): Purpose: To report midterm results of the "pave-and-crack" technique to facilitate safe and effective scaffolding of heavily calcified femoropopliteal lesions in preparation for delivery of a Supera interwoven stent. Methods: Data were collected retrospectively on 67 consecutive patients (mean age 71 +/- 8 years; 54 men) treated with this technique between November 2011 and February 2017 at a single center. A third (22/64, 34%) of the patients had critical limb ischemia (CLI). Most lesions were TASC D (52/67, 78%), and the majority were occlusions (61/66, 92%). The mean lesion length was 26.9 +/- 11.2 cm. Nearly two-thirds (40/64, 62%) had grade 4 calcification (Peripheral Arterial Calcium Scoring System). To prepare for Supera stenting, the most heavily calcified segments of the lesion were predilated aggressively to obliterate recoil. A Viabahn stent-graft was then implanted to "pave" the lesion and protect from vessel rupture as aggressive predilation continued until the calcified plaque was "cracked" before lining the entire lesion with a Supera stent. Patency and target lesion revascularization (TLR) rates were estimated using the Kaplan-Meier method. Results: Procedural success was achieved in 100% and technical success (residual stenosis <30%) in 98% (66/67). The mean cumulative stent lengths were 16 +/- 9 cm for the Viabahn and 23 +/- 12 cm for the Supera. Only 2 complications occurred (distal embolization and access-site pseudoaneurysm). Two CLI patients died within 30 days, and 3 patients (all claudicants) underwent a TLR. Patients were followed for a mean 19 +/- 18 months, during which another 2 CLI patients died and I patient had a major amputation. One-year primary and secondary patency estimates were 79% and 91%, respectively; freedom from TLR was 85%. Conclusion: Despite severe lesion calcification, patients experienced high technical success and a safe and durable therapy at midterm follow-up with the femoropopliteal "pave-and-crack" technique.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 9