Above and below knee femoropopliteal VIABAHN®

Objectives To assess the clinical outcomes of VIABAHN® stent grafts deployed across the knee to those deployed above the knee. Background The placement of stent-grafts across the knee joint and extending into the distal popliteal artery has been avoided due to a perceived higher risk of stent fractures, restenosis, and thrombosis due to the unique hemodynamic forces in this region. Methods A retrospective evaluation was conducted of 114 patients in 127 limbs. Patients were divided into two groups based on the location of the distal end of the deployed VIABAHN® stent: above knee (AK) (n = 89) in which the VIABAHN® implant ended at or above the femoral condyles and below the knee (BK) (n = 38) with extension of the graft into the below knee popliteal segment. Study end points were loss of primary, assisted, and secondary patency. Results One year primary, assisted, and secondary patency rates in the AK versus BK group were 67.7% vs. 47.2% (P = 0.0092), 77.1% vs. 53.7% (P = 0.0022), and 86.3% vs. 59.8% (P = 0.0035), respectively. Univariate analysis demonstrated an increased relative risk of a primary [RR = 2.07 (P = 0.001)], assisted [RR = 2.34 (P = 0.002)], or secondary events [RR = 2.98 (P = 0.002)] in patients when the stent was placed below the femoral condyles. Major amputations occurred in 10% of AK and 34% of BK patients (P = 0.002). Conclusions VIABAHN® stent grafts have a significantly lower clinical patency and higher rates of amputation when they extend across the knee joint.