Does Heparin-bonding Improve Results of Viabahn-Assisted Subintimal Recanalization for TransAtlantic Inter-Society Consensus D Femoropopliteal Artery Disease

Objectives: This study assessed if heparin bonding improves patency of subintimal recanalization of TransAtlantic Inter-Society Consensus (TASC) D femoropopliteal disease using Viabahn stents. Methods: We compared patients receiving standard (group I, n 20) or heparin-bonded (group II, n 19) expanded polytetrafluoroethylenecovered stents for Viabahn-assisted subintimal recanalization (VASIR) of severe (TASC D) femoropopliteal artery occlusive disease. Demographics, comorbidities, presenting symptoms, treated length, improvement in anklebrachial index (ABI), patency assessed by ABI and duplex imaging, and length of follow-up were examined. Results: The age difference between groups was not significant in group I (70.7 12.1 years) vs group II (64.8 13.9 years), nor were differences in sex (M/F: 9/9 vs 8/8, respectively), comorbidities, or presenting symptoms. Although the treated length of artery was slightly greater in group II (29.9 10.8 vs 32.4 4.5 cm, P .016), improvement in ABI was similar in group I (0.41 0.16) vs group II (0.51 0.17), as was mean length of follow-up (18.3 6.3 vs 18.2 6.0 months, respectively). Although life-table 1-year primary patency was not significantly different between the two groups (group I, 68%; group II, 79%; log-rank P .62), assisted primary (group I, 73%; group II, 89%; P .11) and secondary patency (group I, 71%; group II, 89%, P .21) tended to be greater in group II vs group I, primarily because of fewer early thrombotic failures in group II. However, some 5-mm grafts were used early on in group I only, and with these grafts excluded, the patency differences between groups I and II were minimal, suggesting no benefit to heparin-bonding for grafts 6 mm (P .49 for primary, assisted primary, and secondary patency). Notably, patencies in both groups were similar to those reported for above-knee expanded polytetrafluoroethylene bypass. Conclusions: Heparin-bonding does not appear to improve patency in VASIR compared with standard Viabahn stent grafts, making it difficult to justify the added expense; but maintaining patency in a failing graft to allow timely salvage intervention may be an important benefit, particularly in smaller-diameter grafts. Patient selection may be a more important predictor of success than heparin bonding. This preliminary study with small sample sizes requires larger samples and longer follow-up to further explore the role of heparin-bonded grafts in VASIR.