BACKGROUND: This study investigates the frequency of functional stenoses (FS) after stent implantation into the femoropopliteal artery (FPA) detected on lateral angiograms with the knee flexed and evaluates the impact on additional treatment. METHODS: Retrospectively we identified 42 patients with stent-based revascularizations of the FPA in whom a final lateral digital subtraction angiography (DSA) with the knee in a flexed position (functional angiography [FA]) had been performed. In 32 patients' location, frequency and additional treatment of FS as well as stent-type. landing zones, angle of the knee-joint during FA and patency rates were evaluated. RESULTS: Mean lesion length was 12.9 +/- 20.16cm, 26/32 patients (81%) had a CTO. In 5/32 patients (15.6%) a FS was detected by FA: in three patients FS was located proximal and in two patients distal to a Supera (R) stent (Abbott Laboratories, Chicago, IL, USA). FS of the proximal landing zones were within the distal SFA (N.=2) or PI segment (N.=1) and FS of the distal landing zone were within the P3 segment (N.=2). In all three proximal FS additional overlapping stent implantation was performed. The distal FS went untreated in order to preserve the P3 segment for a bypass option. Mean angle of FA was 98.1 degrees +/- 31.7 degrees. Patency at 12 months did not differ between patients with (treated) FS (50%) and those without FS (72%) (P=0.240). CONCLUSIONS: Functional stenosis after stent-based revascularization of the FPA by use of a device with increased radial force occurs rather frequently. Proximal functional stenosis can be successfully treated by overlapping stent implantation. However, clinical relevance of functional stenosis needs further investigation.

To evaluate technical success, safety and efficacy of post-dilatation of an interwoven nitinol stent using a paclitaxel-coated balloon (PCB) for revascularization of complex femoro-popliteal lesions. Thirty patients (26 male, mean age 70 ± 7 years) suffering from peripheral artery disease (PAD) (Rutherford category II–III) underwent revascularization of chronic total occlusions (n = 22, 73%) or severe stenosis (n = 8, 27%) of the femoro-popliteal segment. Mean lesion length was 251 ± 85 mm. Lesions were treated by pre-dilatation (POBA), implantation of a helical interwoven stent and post-dilatation with a PCB. Technical success was defined as residual stenosis < 30%. Follow-up included clinical visits, duplex ultrasound and ABI at 6 and 12 months. Endpoints were patency (re-stenosis < 50%), complications, improvement of Rutherford category and ABI. Regarding patency two sub-groups were compared: long-(“LL”; < 25 cm, n = 12, mean 175 ± 38 mm) and ultra-long lesions (“ULL”; ≥ 25 cm, n = 13, mean 322 ± 43 mm). Technical success was 100%. In 1/30 patients (3.3%), a minor complication occurred (embolism). The overall primary and secondary patency rates at 12 months were 80.0% (95% CI 72.5–96.9%) and 92.0% (95% CI 84.7–100%). In the LL-sub-group, primary patency was 100%, and in the ULL-sub-group, primary patency was 61.5% (95% CI 51.8–92.3%) (p = 0.056), and secondary patency 84.6% (95% CI 71.3–100%), respectively. Rutherford category increased by at least one category in 92% of patients, ABI increased from 0.52 ± 0.13 (baseline) to 0.9 ± 0.14 (12 months) (p = 0.001). Five patients underwent target lesion revascularization during follow-up (bypass: n = 1, endovascular: n = 4). No death was observed during follow-up. Post-dilatation of an interwoven nitinol stent using a paclitaxel-coated-balloon proved to be safe and effective with promising outcomes in long- and ultra-long lesions up to 12 months of follow-up.

Background Accurate vessel sizing might affect treatment outcome of endovascular therapy. Purpose To compare accuracy of peripheral vessel diameter measurements using pre-interventional computed tomography angiography post processing software (CTA-PPS) and extravascularly located calibrated devices used during digital subtraction angiography (DSA) with an intravascular scaled catheter (SC). Material and Methods In 33 patients (28 men, mean age = 72 ± 11 years) a SC was used during DSA of the femoro-popliteal territory. Simultaneously, one scaled radiopaque tape (SRT) was affixed to the lateral thigh, one scaled radiopaque ruler (SRR) was positioned on the angiography table. For each patient, diameters of five anatomic landmarks were measured on DSA images after calibration using different scaled devices and CTA-PPS. Diameters were compared to SC (reference) and between groups of non-obese (NOB) and obese (OB) patients. Results In total, 660 measurements were performed. Compared to the reference, SRT overestimated the diameter by 1.2% (range = -10–12, standard deviation [SD] = 4.1%, intraclass correlation coefficient [ICC] = 0.992, 95% confidence interval [CI] = 0.989–0.992, P = 0.01), the SRR and CTA-PPS underestimated it by 21.3% (range = 1–47, SD = 9.4%, ICC = 0.864, 95% CI = 0.11–0.963, P = 0.08) and 3.2% (range = 17–38, SD = 9.7%, ICC = 0.976, 95% CI = 0.964–0.983, P = 0.01), respectively. Underestimation using the SRR was greatest in the proximal superficial-femoral artery (31%) and lowest at the P2 level of the popliteal artery (15%). In the NOB group, diameter overestimation of the SRT was 0.8% (range = 4–7, SD = 4.2%, B = 0.071, 95% CI = 0.293–0.435, P = 0.08) compared to the OB group of 1.6% (range = −7–4, SD = 2.9%, B = 0.010, 95% CI = 0.474–0.454, P = 0.96). Diameter underestimation of the SRR was 17.3% (range = 13–21, SD = 3.1%, B = 0.946, 95% CI = 0.486–1.405, P = 0.002) in the NOB group, 23.3% (range = 11–36, SD = 6.6%, B = 0.870, 95% CI = 0.268–1.472, P = 0.007) in the OB group. Conclusion For calibrated measurements SRT and CTA-PPS prove accurate compared to the reference, while SRR does not. Obesity has a significant impact on underestimation of diameter if SRR is used.