Daniel B. Walsh, MD, Richard J. Powell, MD, Therese A. Stukel, PhD, E

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Presentation transcript:

Superficial femoral artery stenoses: Characteristics of progressing lesions Daniel B. Walsh, MD, Richard J. Powell, MD, Therese A. Stukel, PhD, E.Lynne Henderson, MD, Jack L. Cronenwett, MD Journal of Vascular Surgery Volume 25, Issue 3, Pages 512-521 (March 1997) DOI: 10.1016/S0741-5214(97)70262-3 Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 SFA lesion classification scheme based on morphologic condition. Adopted from Ambrose JA, Winters SL, Arora RR, et al. Arteriographic evolution of coronary artery morphology in unstable angina. J Am Coll Cardiol 1986;7:472-8. Journal of Vascular Surgery 1997 25, 512-521DOI: (10.1016/S0741-5214(97)70262-3) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Stenosis progression rate based on initial stenosis severity for all lesions. A, Lesions originating from previously normal appearing regions of SFA (n = 27). B, Lesions initially of 0% to 24% stenosis (n = 29). C, Lesions initially of 25% to 49% stenosis (n = 30). D, Lesions initially ≥50% stenosis (n = 12). Note that many lesions in all categories remained stable, whereas some in all categories progressed rapidly. Solid lines, Stable lesions; broken line, lesions progressing ≥20% or occluding. Journal of Vascular Surgery 1997 25, 512-521DOI: (10.1016/S0741-5214(97)70262-3) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Stenosis progression rate based on initial stenosis severity for all lesions. A, Lesions originating from previously normal appearing regions of SFA (n = 27). B, Lesions initially of 0% to 24% stenosis (n = 29). C, Lesions initially of 25% to 49% stenosis (n = 30). D, Lesions initially ≥50% stenosis (n = 12). Note that many lesions in all categories remained stable, whereas some in all categories progressed rapidly. Solid lines, Stable lesions; broken line, lesions progressing ≥20% or occluding. Journal of Vascular Surgery 1997 25, 512-521DOI: (10.1016/S0741-5214(97)70262-3) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Stenosis progression rate based on initial stenosis severity for all lesions. A, Lesions originating from previously normal appearing regions of SFA (n = 27). B, Lesions initially of 0% to 24% stenosis (n = 29). C, Lesions initially of 25% to 49% stenosis (n = 30). D, Lesions initially ≥50% stenosis (n = 12). Note that many lesions in all categories remained stable, whereas some in all categories progressed rapidly. Solid lines, Stable lesions; broken line, lesions progressing ≥20% or occluding. Journal of Vascular Surgery 1997 25, 512-521DOI: (10.1016/S0741-5214(97)70262-3) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Stenosis progression rate based on initial stenosis severity for all lesions. A, Lesions originating from previously normal appearing regions of SFA (n = 27). B, Lesions initially of 0% to 24% stenosis (n = 29). C, Lesions initially of 25% to 49% stenosis (n = 30). D, Lesions initially ≥50% stenosis (n = 12). Note that many lesions in all categories remained stable, whereas some in all categories progressed rapidly. Solid lines, Stable lesions; broken line, lesions progressing ≥20% or occluding. Journal of Vascular Surgery 1997 25, 512-521DOI: (10.1016/S0741-5214(97)70262-3) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Despite initial 30% stenosis in proximal SFA with minimal adductor canal disease (left), SFA occlusion occurred in adductor canal region after 20 months of follow-up with progression but not occlusion of initially more severe stenosis (right). Journal of Vascular Surgery 1997 25, 512-521DOI: (10.1016/S0741-5214(97)70262-3) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Despite initial 30% stenosis in proximal SFA with minimal adductor canal disease (left), SFA occlusion occurred in adductor canal region after 20 months of follow-up with progression but not occlusion of initially more severe stenosis (right). Journal of Vascular Surgery 1997 25, 512-521DOI: (10.1016/S0741-5214(97)70262-3) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Effect of SFA stenosis on probability of SFA occlusion during 2- to 3-year follow-up predicted by logistic regression analysis. Only stenoses >50% in adductor canal have probability of occlusion >50%. Lesions outside adductor canal have low probability of occlusion independent of initial stenosis severity. Journal of Vascular Surgery 1997 25, 512-521DOI: (10.1016/S0741-5214(97)70262-3) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 High-grade (75%) SFA stenosis (left) that remained unchanged during 4 years of follow-up (right). Although such lesions might be considered for “prophylactic” endovascular treatment, our analysis indicates that most do not progress to occlusion over next 2 to 3 years. Journal of Vascular Surgery 1997 25, 512-521DOI: (10.1016/S0741-5214(97)70262-3) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 High-grade (75%) SFA stenosis (left) that remained unchanged during 4 years of follow-up (right). Although such lesions might be considered for “prophylactic” endovascular treatment, our analysis indicates that most do not progress to occlusion over next 2 to 3 years. Journal of Vascular Surgery 1997 25, 512-521DOI: (10.1016/S0741-5214(97)70262-3) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions