November 04, 2009

Full Metal Jacket of the Superficial Femoral Artery: A Retrospective Analysis

Parth S. Shah, MD, MPH, Anil Hingorani, MD, Enrico Ascher, MD, Natalia Marks, MD RVT, Alexander Shiferson, DO, Kapil Gopal, MD, Srinivas Reddy, MD, Daniel Jung, MD, Theresa Jacob, PhD.
Maimonides Medical Center, Brooklyn, NY, USA.

OBJECTIVES:
The technique of full metal jacket (FMJ) of the superficial femoral artery (SFA) has been associated with poorer short and long term results. However, routine stenting of the SFA has been shown in a prospective randomized trial to be associated with superior results. To further investigate this issue, we examined our experience with FMJ of the SFA.
METHODS:
Retrospective data was gathered for peripheral angioplasties and stenting for the time period between January 2005 and December 2008. The cases of FMJ stenting of the SFA were identified by angiographic findings and the operative dictations providing the stent data. The selective FMJ stenting of SFA was performed for the residual stenosis after balloon angioplasty of SFA due to either dissection or significant recoil. The end points of the follow-up were defined as evidence of restenosis on arterial duplex or angiographic findings or re-intervention or death. The cases with concomitant iliac artery angioplasty and/or stenting were excluded from the dataset for analysis.
RESULTS:
63 cases of FMJ of the SFA were identified from database of 1353 patients who had peripheral endovascular intervention between the time period between January 2005 and December 2008. Average age of the patients being 70 (standard deviation: 10.1) and the median primary patency rate was 9 months (95% CI: 5.06 - 12.94). The most common indication was intermittent claudication (65%; 41/63) followed by tissue loss (23%; 15/63). Average creatinine level was 1.67 (standard deviation: 2.03) and 49% of the patients were diabetics. Multivariate logistic regression analysis showed that diabetes (OR: 0.33; p= 0.044, 95% CI: 0.11 - 0.97) and creatinine ≥ 1.6 (OR 0.16; p=0.038, 95% CI: 0.03 - 0.9) were the independent risk factors for less than 6 months patency rates.
CONCLUSIONS:
Our experience suggests promising results for the technique of FMJ of the SFA and that further examination of the technique is warranted.

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