Implications of Early Failure of Superficial Femoral Artery Endoluminal Interventions

Although the long-term (>30 days) effects of endoluminal treatment of superficial femoral artery (SFA) disease have been well studied, the implications of early (≤ 30 days) failure are still unclear. We examined the consequences of early failure after endovascular treatment of the SFA. We anticipate that early failure will not be associated with significant morbidity and mortality and will not interfere with surgical bypass options. A prospective database of patients undergoing endovascular treatment of the SFA between 1986 and 2004 was maintained. Intention-to-treat analysis was performed. Angiograms were reviewed in all cases to assess lesion characteristics and pre- and post procedure runoff. Results were standardized to current Transatlantic Intersociety Consensus (TASC) and Society for Vascular Surgery (SVS) criteria. There were 441 limbs in 360 patients (70% male, average age 65 years) that underwent endovascular treatment. There was early failure in 39 procedures (8%). Twenty-nine cases (74%) failed immediately (<24 hr), and 10 cases (26%) failed within the first 30 days following intervention. Factors that predicted failure were TASC category D and preprocedural SVS symptom grade ≥5. The 90-day mortality in the group was 0%, and major morbidity was 4%. No emergent endovascular intervention, bypass, or unplanned amputation occurred within 30 days of these failures. There was no change in the level of amputation or the level of distal anastomosis of a bypass graft as a result of an early failure. Early failure of endoluminal therapy for SFA disease is not associated with significant morbidity and mortality. Options for surgical bypass are not compromised, and the amputation level is not altered. Aggressive endoluminal approaches to SFA disease should be considered as a first-line therapy in all patients.