LAUSR

OBJECTIVES Covered stents (CS) to treat superficial femoral artery (SFA) occlusive disease have become more common. However, concerns about patients presenting with acute limb ischemia (ALI) after failure due to coverage of important collaterals have been raised. Herein, we determine if CS are associated with ALI after failure. METHODS VQI peripheral vascular intervention (PVI) and infrainguinal bypass datasets were queried from 2010 to 2020 for patients who underwent SFA stenting with bare-metal stent (BMS) or CS and who also had a subsequent ipsilateral SFA endovascular reintervention or bypass recorded in the VQI. The initial SFA stenting procedure will be referred to the index procedure and the subsequent procedure will be referred to as the reintervention. Patients with aneurysmal pathology, prior infrainguinal bypass, and ALI at index procedure were excluded. Patients with pre-index inflow/outflow procedures were not excluded. The primary outcome was ALI at reintervention. Other outcomes included higher degree of ischemia (claudication vs rest pain vs tissue loss vs ALI) and reoperative factors. Predictors of the primary outcome were determined with multivariable logistic regression. Index treatment length and pre-index ankle-brachial index were forced into the model. RESULTS There were 3,721 patients: 3,338 with index BMS, 383 with index CS. Mean age was 66.3±11.0; 59.2% were male. Baseline covariates were similar between the groups; during the index procedure, more BMS patients underwent plain balloon angioplasty (68.7% vs. 62.1%; p=0.001) and had shorter total index treatment length (median 15.0 [IQR: 10.0-25.0] vs. 20.0 [IQR:12.0-30.0] cm; p<0.001). At reintervention, ALI was the presenting symptom for 12.0% of the CS cohort, versus 6.3% of the BMS cohort (p<0.001). More patients with an index CS underwent major amputation at the time of reintervention (2.6% vs. 1.0%; p=0.006). Reinterventions for the CS patients more often utilized bypass, pharmacologic thrombolysis, and mechanical thrombolysis. CS at index procedure was a predictor of ALI at reintervention (OR 1.87; 95% CI: 1.31-2.65; p=0.001) while controlling for age, time difference between procedures, BMI, COPD, preoperative anticoagulation and antiplatelet, prior carotid intervention and major amputation, index procedure fluoroscopy time and treatment length, and pre-index ankle-brachial index. CONCLUSION In patients undergoing reintervention for failed SFA stents, CS are more likely to present with ALI than those with failed SFA BMS.