ePTFE covered stents in occlusive SFA disease: clinical and experimental studies

Periferal arterial occlusive disease (PAOD) is an affliction that affects up to 20% of patients over the age of 60 (1). It is defined as atherosclerosis caudal of the aortic bifurcation resulting in Intermittent Claudication. This in turn is defined as reproducible muscle pain of the lower extremities due to impairment of oxygenation during exercise (therapy). The Fontaine grading system is based on these clinical features and is administered, together with other classification systems to assess the severity of this affliction. Some 25% of patients develop progression of these symptoms, where critical limb ischaemia is manifested in 0,025% in a normal population (2) requiring some form of surgery or intervention.

Although bypass surgery is still a key component in the treatment of tissue loss in patients with critical limb ischaemia, we can see that endovascular techniques are increasingly administered and in some instances taking over the role of bypass surgery. This is not only due to quality improvements of stents, stent grafts and techniques, but also because it needs less extensive surgery. Over the past decade we have seen a gradual improvement of medium and long-term patency results of endovascular procedures (3,4,5). The critically ill patient does not necessarily need to be hospitilized for longer periods of time with complications that go with it, not to mention the costs. Since some 55% of patients diagnosed with Chritical Limb ischaemia will die the first 2 year, treatment should not only focus on risk factor treatment but also on quality of life in short and long term by preventing limb loss (6). Thus, in the aim to do just that in these patients one should investigate whether these were durable techniques for lower limb ischaemia.

General aims of this thesis

The aim of this thesis is to report on the currently available knowledge on results in bypass surgery, particularly focussing on complication rates over the last decade. The aim is also to look into our Superficial Femoral Artery (SFA) endovascular treatment results of occlusive disease. In the latter we focus on the role and significance of collateral system flow and its relevance in clinical decision making.