Background Image
Table of Contents Table of Contents
Previous Page  37 / 92 Next Page
Information
Show Menu
Previous Page 37 / 92 Next Page
Page Background

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 4, July/August 2016

AFRICA

239

were performed under spinal or local anaesthesia. The anaesthesia

protocol was selected according to patient compliance.

During the procedure, anticoagulation was provided by the

administration of 100–300 U/kg of heparin. Following the

procedure, 150 mg of clopidogrel (Plavix

®

, Sanofi, Turkey)

was used as the anti-aggregant treatment protocol for patients

who did not have any contraindications, and the treatment was

subsequently continued with a dose of 75 mg/day.

The patients were monitored post-operatively in the first

week, and second and sixth months. After one year, there were

no significant clinical symptoms in any of the 43 patients. The

mean follow-up period was 32 months. Digital subtraction

angiography (DSA) was used to examine nine randomly selected

patients, whereas colour Doppler ultrasonography (USG) was

used to examine 52 randomly selected patients. Four symptomatic

patients were evaluated separately.

Statistical analysis

For analysis of the demographic, pre-operative, operative and

postoperative data, and comparison of the median

±

t

standard

deviation results of the group, categorical data chi-squared

tests were performed using the Statistical Package for the Social

Sciences (SPSS Inc, Chicago, Illinois, USA) 17.0 statistics

software;

p <

0.05 was considered significant.

Results

Twenty-seven patients had diabetes, 38 had hyperlipidaemia,

and seven had chronic obstructive pulmonary disease. Fifteen

patients underwent coronary bypass surgery or were diagnosed

with coronary artery disease (Table 1).

Sixty-five patients were examined with DSA or colour

Doppler USG. DSA was performed in all symptomatic patients,

and Doppler USG was performed in all patients.

In-stent restenosis was defined as

50% stenosis in the stent

area in asymptomatic patients. The procedure was repeated if the

degree of stenosis was

70%. None of the nine asymptomatic

patients who were examined with DSA had

50% lesions. Three

patients who were examined with colour Doppler USG had

50–70% lesions (two patients had a superficial femoral artery

lesion; one had a popliteal arterial stent). None of the patients

had

70% lesions.

In total, 46 patients had type A lesions, 12 had type B lesions,

five had type C lesions, and two had type D lesions, according

to the TASC classification scheme.

9

Sixteen out of 65 patients

(24.6%) were female and 49 (75.4%) were male (Table 1).

The total number of stents used was 92, and the mean number

of stents per patient was 1.42.

1-3

The mean stent length was 53

mm per patient (36–108 mm). Twenty-two stents (24%) were

implanted into the right superficial femoral artery, 31 (33.7%)

into the left superficial femoral artery, 14 (15.2%) into the left

iliac artery, 17 (18.4%) into the right iliac artery, five (7.8%) into

the left popliteal artery, and three (3.2%) into the right popliteal

artery. The size of the stents ranged between 5 and 8 mm; the

most commonly used stent width was 6 mm.

The procedure was performed under spinal anaesthesia in

five patients (7.7%) and local anaesthesia in 60 patients (92.3%)

(Table 2). There was 100% success rate of the procedure. In all

patients, it was possible to palpate the pulse with a hand on the

distal part of the stent zone after the procedure. There was no

limb loss in any patient.

The mean follow-up period was 32 months (18–48 months),

and in-stent restenosis developed in three patients. These

patients received a secondary balloon dilatation procedure. The

superficial femoral artery stent was fully occluded in one patient,

and the patient underwent femoropoliteal bypass. The remaining

patients have had no complications from the stenting.

During the follow-up period, DSA was performed in all

patients who were admitted symptomatically (four patients).

Total occlusion was observed in one patient and 70–90% stenosis

was observed in three patients (all patients had a superficial

femoral artery stent) (Table 3). All patients were alive, so the

Kaplan–Meier life curve was not included in the text, and we

used single-group analysis.

Discussion

This was a unique study demonstrating the results of mid-term

peripheral application of biodegradable stents. The findings of

this study show that biodegradable stents had successful clinical

outcomes during an average of 32 months’ follow-up period.

It appears from this study that biodegradable stents have good

mid-term patency rates in peripheral arterial occlusions.

In patients with limb ischaemia, the first-line approach for

revascularisation has shifted over the past decade from bypass

surgery to endovascular intervention.

10

Stenting for the treatment

of lower-extremity arterial occlusive disease is an important tool

and continues to evolve, with new stent designs and technologies

being developed to provide superior patency rates and limb

salvage.

11,12

Table 1. Laboratory data and vascular pathology of patients.

Mean age

±

SD = 64.11

±

24.13 years

Parameters

n

%

Gender (M/F)

49/16 75.4/24.6

TASC type A lesion

46

70.7

TASC type B lesion

12

20.0

TASC type C lesion

5

8.3

TASC type D lesion

2

3.3

Diabetes mellitus

27

41.5

Hyperlipidaemia (LDL > 130 mg/dl or 3.37 mmol/l)

38

58.4

COPD

7

10.7

Coronary artery disease (diagnosed)

15

23

TASC: TransAtlantic Inter-Society Consensus; LDL: low-density lipoprotein

cholesterol; COPD: chronic obstructive pulmonary disease.

Table 2. Stent features and sites for stent therapy in patients

Stents

Total number of stents (

n

)

92

Mean stent diameter (mean

±

SD mm)

6.9

±

1.3

Stent length per patient (mean

±

SD mm)

53.0

±

14.6

Restenosis (

n

/%)

7/7.6

Application area (

n

/%)

Superficial femoral artery

53/57.6

Iliac artery

31/33.7

Popliteal artery

8/8.7

Anaesthesia (

n

/%)

Local

60/92.3

Spinal

5/7.7