The role of stent-grafts for prevention and treatment of restenosis.

Restenosis rates in the superficial femoral artery remain high in patients treated with balloon angioplasty or bare metal stents. Stent-grafts represent an alternative endovascular treatment modality for these patients. In the US, the only FDA-approved stent-graft for femoral use is the Viabahn endoprosthesis (W.L. Gore, Flagstaff, AZ). The Viabahn is constructed of nitinol and ePTFE and has a proprietary heparin bioactive surface. Stent-grafts have the potential to reduce restenosis by impeding intimal hyperplasia and reducing tissue in-growth; however, the problem of edge restenosis has not been eliminated. Graft thrombosis remains an important mode of stent-graft failure. The Viabahn has been shown in observational studies and randomized trials to be an effective and safe treatment strategy compared to bare self-expanding stents and surgical prosthetic bypass grafts. Patient and appropriate lesion selection remain important in achieving long term patency. In this paper, we review the data surrounding the use of stent-grafts in the SFA to prevent and treat restenosis. Important technical considerations specific to the use of the Viabahn are also discussed.