The Long-term Incidence And Related Risk Factors Of In-stent Restenosis After Superficial Femoral Artery Stenting

Objective:The aim of this study was to assess the long-term incidence and related risk factors of in-stent restenosis(ISR)in superficia I femoral artery stenting.Methods:A retrospective study was conducted in patients with stent implantation of superficial femoral artery stenosis or occlusion from January 2013 to December 2014 for the Center(Capital Medical University,Xuanwu Hospital).All the 9 patients who were unable to follow up due to amputation and death were excluded from this study,there were a total of 68 cases(71 limbs).The incidence of SFA-ISR and related risk factors were analyzed statistically for the first,second and third years.Patient-related factors include general conditions,complications,postoperative medication.The general situation includes gender,age,and smoking history.Complications include hypertension,diabetes,coronary heart disease,hyperlipidemia,cerebrovascular disease,renal insufficiency.Postoperative medication including postoperative compliance with the medication,cilostazol group and non-cilostazol group.Vascular related factors include lesion length,stenosis or occlusion,TASC II grade(AB and CD).Stent-related factors include stent length,stent type(metal bare stent or stent graft)and stent brand.The values are expressed as mean ± standard deviation.The chi-square test was performed on the counting data.The independent-samples T Test was performed on measurement data.The related factors of P﹤ value0.1 was incorporated into the binary logistics multivariate analysis.P ﹤0.05 was considered statistically significant.Results:The first and second follow-up patients were 68 patients,71 limbs,the third year followed up 34 patients,37 limbs.The incidence of SFA-ISR in the first,second and third years was 46.5%,60.6% and 64.9% respectively.TASCⅡC + D lesions(P ﹤0.001),Occlusive lesions(P ﹤0.001),Lesion length(19.30 ± 5.277 cm vs.12.16 ± 3.606 cm,P ﹤0.001),the length of the stent(27.27 ± 11.53 cm vs.14.53 ± 6.336 cm,P ﹤0.001),were positively correlated with the incidence of SFA-ISR in the first year.Multivariate analysis showed that smoking was also a risk factor for SFA-ISR for the first year.TASCⅡC + D lesions(P = 0.003),occlusive lesions(P = 0.001),lesion length(17.53 ± 5.713 cm vs.12.32 ± 4.047 cm,P ﹤0.001),stent coverage length(24.28 ± 11.699 cm vs.14.57 ± 6.839,P ﹤0.001)were positively correlated with the incidence of SFA-ISR in the second year.TASCⅡC + D lesions(P = 0.003),lesion length(17.83±5.623 cm vs.10.85±4.140 cm,P ﹤ 0.001),the length of the stent was(26.13±11.532 cm vs.14.62±7.730 cm,P=0.001)were positively correlated with the incidence of SFA-ISR in the third year.Conclusion:The longer the stent length,the higher the incidence of restenosis in the superficial femoral stent,It may be appropriate to reduce the length of stent under the condition of covering the lesion length Or to take measures to prevent vascular intimal hyperplasia caused by superficial femoral stenting.Smoking is a risk factor for restenosis in the superficial femoral artery.postoperative patients should be actively recommended to quit smoking;TASC Ⅱ C + D grade,occlusive lesions,length of lesion,length of stent coverage were the risk factors of SFA-ISR.The patients with high risk factors should be followed up closely,then the ISR can be diagnosed and treated in time.