gore viabahn® versus plain old balloon angioplasty (poba) for superficial femoral artery (sfa) in-stent restenosis

Conditions: Peripheral Vascular Disease

Summary: this is a prospective, randomized, multi-center study recruiting patients with an in-stent restenosis in the superficial femoral artery. the safety and efficacity of the viabahn endoprosthesis (w.l. gore \& associates), a heparin-bonded endoprosthesis, is compared with plain old balloon angioplasty (poba). in 4 belgian and 2 german centers a total of 80 patients will be recruited. primary endpoint is primary patency at 12 months, defined as no evidence of restenosis or occlusion within the originally treated lesion based on color-flow duplex ultrasound (cfdu) measuring a peak systolic velocity ratio ≤2.5, and without target lesion revascularization (tlr) within 12 months. in comparison to poba, it is expected that the use of the viabahn endoprosthesis (w.l. gore \& associates) will result in greater 12 month primary patency of treated superficial femoral artery in-stent restenotic lesions.


Eligibility criteria:
general inclusion criteria: * patient presenting with lifestyle-limiting claudication, rest pain or minor tissue loss (rutherford classification from 2 to 5) * patient is willing to comply with specified follow-up evaluations at the specified times * patient is \>18 years old * patient understands the nature of the procedure and provides written informed consent, prior to enrolment in the study * patient has a projected life-expectancy of at least 24 months * noninvasive lower extremity arterial studies (resting or exercise) demonstrate ankle-brachial index ≤0.8 * patient is eligible for treatment with the viabahn® endoprosthesis (w.l. gore) * male, infertile female, or female of child bearing potential practicing an acceptable method of birth control with a negative pregnancy test within 7 days prior to study procedure angiographic inclusion criteria * restenotic or reoccluded lesion located in a stent which was previously implanted (\>30 days) in the superficial femoral artery, suitable for endovascular therapy * total target lesion length between 4 and 27 cm (comprising in-stent restenosis and adjacent stenotic disease) * minimum of 1.0cm of healthy vessel (non-stenotic) both proximal and distal to the treatment area * popliteal artery is patent at the intercondylar fossa of the femur to p3 * target vessel diameter visually estimated to be \>4mm and \<7.6 mm at the proximal and distal treatment segments within the sfa * guidewire and delivery system successfully traversed lesion * there is angiographic evidence of at least one-vessel-runoff to the foot, that does not require intervention (\<50% stenotic) exclusion criteria : * untreated flow-limiting aortoiliac stenotic disease * presence of a chronic total occlusion, i.e. a complete occlusion of the failed bare stent that cannot be re-opened with thrombolysis or does not allow easy passage of the guidewire by the physician * any previous surgery in the target vessel * severe ipsilateral common/deep femoral disease requiring surgical reintervention * perioperative unsuccessful ipsilateral percutaneous vascular procedure to treat inflow disease just prior to enrollment * femoral or popliteal aneurysm located at the target vessel * non-atherosclerotic disease resulting in occlusion (e.g. embolism, buerger's disease, vasculitis) * no patent tibial arteries (\>50% stenosis) * prior ipsilateral femoral artery bypass * severe medical comorbidities (untreated cad/chf, severe copd, metastatic malignancy, dementia, etc) or other medical condition that would preclude compliance with the study protocol or 2-year life expectancy * serum creatinine \>2.5mg/dl within 45 days prior to study procedure unless the subject is currently on dialysis * major distal amputation (above the transmetatarsal) in the study or non-study limb * septicemia or bacteremia * any previously known coagulation disorder, including hypercoagulability * contraindication to anticoagulation or antiplatelet therapy * known allergies to stent or stent graft components (nickel-titanium or eptfe) * known allergy to contrast media that cannot be adequately pre-medicated prior to the study procedure * patient with known hypersensitivity to heparin, including those patients who have had a previous incidence of heparin-induced thrombocytopenia (hit) type ii * currently participating in another clinical research trial, unless approved by w.l. gore \& associates in advance of study enrolment * angiographic evidence of intra-arterial thrombus or atheroembolism from inflow treatment * any planned surgical intervention/procedure within 30 days of the study procedure * target lesion access not performed by transfemoral approach.

Keywords: peripheral vascular disease in-stent restenosis endoprosthesis plain old balloon angioplasty