Outcomes of direct puncture of a common femoral artery stent

Abstract

Research question: In patients who have undergone common femoral artery stenting, can the stent be safely and effectively punctured in future vascular procedures without short- or long-term implications?

Background, Significance, and rationale: Concerns with a common femoral artery (CFA) stent include limited access to the CFA for future procedures, increased risk of complications by puncturing a stented vessel, and decreased stent patency. There are no studies published that focus on outcomes of direct puncture of a CFA stent.

Materials and Methods: We retrospectively reviewed the charts from two centers of 295 unique patients with 349 CFA lesions treated with stents from 2012-2021. Among the 349 stented CFAs, we identified 91 unique patients with 108 CFA stents that were punctured at least once. These 108 stents had a total of 223 punctures (multiple stents were punctured more than once), constituting the punctured cohort (PC). There were a remaining 241 CFA stents in the non-punctured cohort (NPC). Indications for the 223 punctures are as follows: rest pain (34%), claudication (32%), gangrene (11%), ulceration (11%), intestinal disorder (2%), carotid disorder (2%), and other (8%). Our primary outcome was patency for the NPC versus the PC. Kaplan-Meier curves were used to evaluate patency. Chi squared tests, analyses of variance, and student’s t tests were used to evaluate differences in risk factors, demographics, and complications between the PC and NPC. Secondary outcomes were total number of punctures per CFA stent and 30-day complications.

Results: There was no statistically significant difference in risk factors, age, or sex between the PC and NPC. The total number of punctures in the PC ranged from 1 to 13 (mean 2.03, SD 2.04). There was no statistically significant difference in closure device failure between the PC and NPC (p = .16). Complications occurred in 0.9% of cases following CFA puncture (respiratory arrest (1) and left calf swelling and pain (1)), and both were unrelated to the puncture site. There were no acute thrombotic complications or infections within 30 days. Kaplan Meier curves showed no difference in primary patency or primary assisted patency for the PC vs NPC.

Conclusion: Direct puncture of CFA stents is safe and effective and does not adversely affect short- or long-term results.