Occluded Superficial Femoral and Popliteal Artery Stents Can Have a Negative Impact on Bypass Target

Purpose: To identify whether occluded femoropopliteal stents influence previously available lower extremity bypass (LEB) targets. Methods: Among 621 consecutive patients who had undergone stenting of a superficial femoral artery or popliteal artery lesion from January 2009 to December 2013, 30 patients (mean age 69.9 +/- 10.2 years; 16 women) were found to have occluded stents. Angiograms before stent placement were analyzed to determine what would have been the optimal distal bypass site, which was compared with the angiogram following stent occlusion. Results: Seven (22%) limbs lost the bypass target. In one limb, the target changed from above-knee to below-knee popliteal, in 2 limbs from above-knee popliteal to tibial, and in 4 limbs from below-knee popliteal to tibial artery. Eleven (34%) limbs required LEB during follow-up. Chronic obstructive pulmonary disease (p=0.007), chronic renal insufficiency (p=0.026), a popliteal artery stent (p=0.001), and the below-knee popliteal artery as an optimal bypass target (p=0.026) were associated with loss of bypass target following stent occlusion. Conclusion: Superficial femoral artery and popliteal artery stent occlusion can affect target vessels in patients who may require subsequent LEB. This should be considered when performing stenting.