Jornal Vascular Brasileiro
Jornal Vascular Brasileiro
Original Article

Tratamento da doença arterial obstrutiva periférica em território femoropoplíteo com stent primário: análise em até 24 meses

Primary stenting for femoropopliteal peripheral arterial disease: analysis up to 24 months

Martin Andreas Geiger; Ana Terezinha Guillaumon

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Resumo: Contexto: O stent primário é uma opção de tratamento bem estabelecida para a doença arterial periférica em território femoropoplíteo. Estudos nacionais são escassos.

Objetivos: Avaliar desfechos clínicos e radiológicos em curto e médio prazo em pacientes classificados como Rutherford 3-6, tratados com o uso de stent em lesões femoropoplíteas.

Métodos: A análise foi realizada com base em um banco de dados prospectivamente mantido de doentes tratados entre julho de 2012 e julho de 2015. O objetivo primário foi a perviedade. Os objetivos secundários foram melhora na classificação de Rutherford, índice tornozelo/braço, revascularização do vaso-alvo, taxa de salvamento do membro e óbito em até 24 meses.

Resultados: Foram incluídos 64 pacientes, sendo 61 com lesões TASC II A/B (95%). A taxa de perviedade primária em 6, 12 e 24 meses foi de 95,2%, 79,1% e 57,9%, respectivamente. A análise de regressão de Cox revelou uma menor perviedade em pacientes com doença oclusiva (RR, 6,64, IC 95%, 1,52-28,99, p = 0,02), bem como uma perda de perviedade cerca de seis vezes maior em doentes TASC B do que TASC A (RR, 5,95, IC 95%, 1,67-21,3, p = 0,0061). Em 12 meses, 90,38% dos doentes permaneceram assintomáticos. A taxa de salvamento do membro em 24 meses foi de 94,3% (IC 95%, 87,9-100%). A ausência de revascularização do vaso-alvo em 24 meses foi de 90,5% (IC 95%, 82,8-98,9%).

Conclusões: Os resultados foram compatíveis com estudos internacionais, apesar do estágio mais avançado da doença vascular observada em nosso grupo. Piores desfechos foram associados a doença oclusiva e lesões complexas.


stents, patência vascular, trombose


Abstract: Background: Primary stenting is a well-established treatment option for femoropopliteal arterial obstructive disease. There is a shortage of Brazilian studies of the subject.

Objectives: To evaluate short and mid-term clinical and radiological outcomes in patients classified as Rutherford 3-6 and treated with stenting of femoropopliteal lesions.

Methods: Analysis based on a prospectively populated database of patients treated from July 2012 to July 2015. The primary endpoint was primary patency. Secondary endpoints were clinical and ankle/brachial index changes. Target Vessel Revascularization, limb salvage rate and death, within a 24-month follow-up period.

Results: 64 patients were enrolled, including 61 TASC II A / B lesions (95%). The primary patency rates at 6, 12, and 24 months were 95.2%, 79.1% and 57.9%, respectively. Cox regression analysis revealed lower patency rates in patients with occlusive disease (hazard ratio [HR], 6.64; 95% confidence interval [CI], 1.52-28,99, p = 0.02), as well as patency loss about 6 times higher in TASC B than in TASC A patients ([HR], 5.95, 95% CI, 1.67-21.3, p = 0.0061). At 12 months, 90.38% of the patients remained asymptomatic. The limb salvage rate at 24 months was 94.3% (95% CI, 87.9-100%). Freedom from TVR at 24 months was 90.5% (95% CI 82.8-98.9%).

Conclusions: Results of primary patency were compatible with international studies, despite the more advanced stage of the vascular disease observed in our group. Occlusive disease and complex lesions were both associated with worse outcomes.


stents, vascular patency, thrombosis


Selvin E, Hirsch AT. Contemporary risk factor control and walking dysfunction in individuals with peripheral arterial disease: NHANES 1999-2004. Atherosclerosis. 2008;201(2):425-33. PMid:18395208.

Rooke TW, Hirsch AT, Misra S, et al. 2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society for Vascular Medicine, and Society for Vascular Surgery. J Vasc Surg. 2011;54(5):e32-58. PMid:21958560.

Adam DJ, Beard JD, Cleveland T, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005;366(9501):1925-34. PMid:16325694.

Fu X, Zhang Z, Liang K, et al. Angioplasty versus bypass surgery in patients with critical limb ischemia-a meta-analysis. Int J Clin Exp Med. 2015;8(7):10595-602. PMid:26379849.

Nguyen BN, Conrad MF, Guest JM, et al. Late outcomes of balloon angioplasty and angioplasty with selective stenting for superficial femoral-popliteal disease are equivalent. J Vasc Surg. 2011;54(4):1051-7.e1. PMid:21636240.

Joviliano EE, Piccinato CE, Dellalibera-Joviliano R, Moriya T, Evora PR. Inflammatory markers and restenosis in peripheral percutaneous angioplasty with intravascular stenting: current concepts. Ann Vasc Surg. 2011;25(6):846-55. PMid:21620656.

Schillinger M, Sabeti S, Loewe C, et al. Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery. N Engl J Med. 2006;354(18):1879-88. PMid:16672699.

Scheinert D, Schmidt A, Zeller T, et al. German center subanalysis of the LEVANT 2 global randomized study of the Lutonix drug-coated balloon in the treatment of femoropopliteal occlusive disease. J Endovasc Ther. 2016;23(3):409-16. PMid:27117972.

Stavroulakis K, Torsello G, Manal A, et al. Results of primary stent therapy for femoropopliteal peripheral arterial disease at 7 years. J Vasc Surg. 2016;64(6):1696-702. PMid:27575816.

Katsanos K, Tepe G, Tsetis D, Fanelli F. Standards of practice for superficial femoral and popliteal artery angioplasty and stenting. Cardiovasc Intervent Radiol. 2014;37(3):592-603. PMid:24722891.

Bosiers M, Deloose K, Callaert J, et al. Results of the Protege EverFlex 200-mm-long nitinol stent (ev3) in TASC C and D femoropopliteal lesions. J Vasc Surg. 2011;54(4):1042-50. PMid:21636239.

Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45(1, Supl S):S5-67. PMid:17223489.

Bisdas T, Borowski M, Torsello G, et al. Current practice of first-line treatment strategies in patients with critical limb ischemia. J Vasc Surg. 2015;62(4):965-73.e3. PMid:26187290.

Geiger M, Deloose K, Callaert J, Bosiers M. Is there already a place for endovascular treatment of the common femoral artery? J Cardiovasc Surg. 2015;56(1):23-9. PMid:25366384.

Vardi M, Novack V, Pencina MJ, et al. Safety and efficacy metrics for primary nitinol stenting in femoropopliteal occlusive disease: a meta-analysis and critical examination of current methodologies. Catheter Cardiovasc Interv. 2014;83(6):975-83. PMid:23996913.

Kasapis C, Henke PK, Chetcuti SJ, et al. Routine stent implantation vs. percutaneous transluminal angioplasty in femoropopliteal artery disease: a meta-analysis of randomized controlled trials. Eur Heart J. 2009;30(1):44-55. PMid:19028778.

Acin F, Haro J, Bleda S, Varela C, Esparza L. Primary nitinol stenting in femoropopliteal occlusive disease: a meta-analysis of randomized controlled trials. J Endovasc Ther. 2012;19(5):585-95. PMid:23046322.

Chowdhury MM, McLain AD, Twine CP. Angioplasty versus bare metal stenting for superficial femoral artery lesions. Cochrane Database Syst Rev. 2014;(6):CD006767. PMid:24959692.

van der Zaag ES, Legemate DA, Prins MH, Reekers JA, Jacobs MJ. Angioplasty or bypass for superficial femoral artery disease? A randomised controlled trial. Eur J Vasc Endovasc Surg. 2004;28(2):132-7. PMid:15234692.

Mwipatayi BP, Hockings A, Hofmann M, Garbowski M, Sieunarine K. Balloon angioplasty compared with stenting for treatment of femoropopliteal occlusive disease: a meta-analysis. J Vasc Surg. 2008;47(2):461-9. PMid:17950563.

Schillinger M, Exner M, Mlekusch W, et al. Inflammatory response to stent implantation: differences in femoropopliteal, iliac, and carotid arteries. Radiology. 2002;224(2):529-35. PMid:12147852.

Schillinger M, Haumer M, Schlerka G, et al. Restenosis after percutaneous transluminal angioplasty in the femoropopliteal segment: the role of inflammation. J Endovasc Ther. 2001;8(5):477-83. PMid:11718406.

Tepe G, Laird J, Schneider P, et al. Drug-coated balloon versus standard percutaneous transluminal angioplasty for the treatment of superficial femoral and popliteal peripheral artery disease: 12-month results from the IN.PACT SFA randomized trial. Circulation. 2015;131(5):495-502. PMid:25472980.

Zeller T, Rastan A, Macharzina R, et al. Drug-coated balloons vs. drug-eluting stents for treatment of long femoropopliteal lesions. J Endovasc Ther. 2014;21(3):359-68. PMid:24915582.

TransAtlantic Inter-Society Consensus. Management of peripheral arterial disease (PAD). TransAtlantic Inter-Society Consensus (TASC). Section D: chronic critical limb ischaemia. Eur J Vasc Endovasc Surg. 2000;19(Supl A):S144-243. PMid:10957907.

Pentecost MJ, Criqui MH, Dorros G, et al. Guidelines for peripheral percutaneous transluminal angioplasty of the abdominal aorta and lower extremity vessels: a statement for health professionals from a Special Writing Group of the Councils on Cardiovascular Radiology, Arteriosclerosis, Cardio-Thoracic and Vascular Surgery, Clinical Cardiology, and Epidemiology and Prevention, the American Heart Association. J Vasc Interv Radiol. 2003;14(9 Pt 2):S495-515. PMid:14514865.

Montero-Baker M, Ziomek GJ, Leon L, et al. Analysis of endovascular therapy for femoropopliteal disease with the Supera stent. J Vasc Surg. 2016;64(4):1002-8. PMid:27444365.

Fowkes FG, Murray GD, Butcher I, et al. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA. 2008;300(2):197-208. PMid:18612117.

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