Covered Stents for the Treatment of SFA Occlusive Disease

C overed stents are composed of fabric or synthetic material supported by a metal mesh or stent platform. Although initially conceived to exclude peripheral arterial aneurysms and treat vessel perforations, the use of covered stents has expanded to act as a barrier to neointimal formation by excluding the vessel wall from the lumen. One such device is the Viabahn Endoprosthesis (Gore & Associates, Flagstaff, AZ), a tube of expanded polytetrafluoroethylene with a self-expanding helical nitinol stent mounted to the outside surface (Figure 1). It is currently approved by the US FDA for use in patients with symptomatic superficial femoral arterial (SFA) lesions with reference vessel diameters of 4.8 to 7.5 mm. This article seeks to provide a case-based review of the various clinical applications of covered stents in the SFA distribution. In 1993, Cragg et al1 reported the use of the first “homemade” covered stent, which was a polytetrafluoroethylene membrane mounted on a Palmaz stent (Cordis Corporation, Warren, NJ) platform for the treatment of long segments of diffuse SFA disease. In 1994, Henry et al published the first report of a manufactured covered stent used in 21 patients with peripheral arterial disease.2 Primary patency rates of 29% to 87% have been reported.3 Use of the Cragg EndoPro System endoprosthesis (Minimally Invasive Technologies SARL, La Ciotat, France), a woven polyester fabric over a nitinol stent platform, was associated with a 59% primary patency rate in the femoropopliteal vessels and a high complication rate. These complications primarily included early and late thrombosis, graft misplacement, and distal embolization.4 The advent of the highly flexible Gore Viabahn Endoprosthesis has provided Covered Stents for the Treatment of SFA Occlusive Disease