Endovascular Grafts in the Treatment of Lower Extremity Occlusive Disease

Indications

It is not clear at present which lesions are best treated with covered stents versus bare-metal self-expanding nitinol stents or ultimately surgical bypass ( Table 1 ). Many interventionists use covered stents for Trans-Atlantic Inter-Society Consensus (TASC) C (>15 cm long) and D (>20 cm long) lesions of the superficial femoral artery ( Figure 1 ). The most commonly used and only U.S. Food and Drug Administration (FDA)-approved stent for this indication is the Viabahn graft (Gore, Flagstaff, AZ). This is a nitinol stent surrounded by expanded polytetrafluoroethylene (ePTFE) that can also include a heparin lining. Viabahn is also used in the popliteal artery; it needs to be carefully sized because this artery often tapers somewhat as it descends. There is a greater likelihood of covering important perigenicular collaterals when the stent is deployed in the popliteal artery. There is no correctly sized self-expanding stent graft for the tibial arteries. The Symphony covered stent is a self-expanding covered nitinol stent with more radial force than the Viabahn. Use of this device in the lower extremity is off label.