Endovascular Repair of Peripheral Arterial Disease Midterm Results From a Single Center Kemal Korkmaz, MD,* Hikmet Selcuk Gedik, MD,* Ali Baran Budak, MD,* Serdar Gunaydin, MD,* and Kerim Cagli, MD† Objective: One thousand consecutive patients who underwent endovas- cular repair in an 8-year period were studied retrospectively to evaluate technical success, freedom from reinterventions, early clinical outcome, and risk factors for restenosis/occlusion. Methods: Mean ± SD Rutherford class was 3.29 ± 0.8. A total of 755 patients have claudication, 423 from rest pain, and 569 from is- chemic ulceration. Results: A total of 552 men and 448 women (mean ± SD = 69.84 ± 8 years; range = 19–89 years) underwent endovascular repair. A total of 698 patients received local anesthesia and 302 general anesthesia. A total of 447 patients received percutaneous transluminal angioplasty, 650 stents were placed; 231 atherectomies were performed and 171 patients received hybrid approach. The procedure was successful in 847 patients (84%). There was no early death. There were 151 early occlusions (95 underwent surgery, 56 received stents), 121 dissections (39 underwent surgery, 56 received stents and 26 medical treatment), 32 hematoma, and 13 early leaks. Mean ± SD Rutherford class improved to 3.02 ± 0.9. Freedom from reintervention rate at 8 years was 76%. A total of 63 patients underwent surgery and 59 cellular therapy. A total of 134 finger, 142 below-knee, and 29 above-knee amputations were reported. Conclusions: Endovascular interventions can be performed with a sat- isfactory technical success and low complication rates; however, nonfa- tal complications and catheter-based reinterventions are frequent. Key Words: Endovascular intervention, Percutaneous transluminal angioplasty, Angiographic surveillance, Peripheral artery disease endovascular. (Innovations 2017;12:287–292) A dvances in endovascular therapies during the previous de- cade have broadened the options for treating peripheral ar- terial disease (PAD) percutaneously. Endovascular treatment offers a lower risk alternative to open surgery in many patients with multiple comorbidities. Key factors for the successful implementation of an endo- vascular program are the ability to select patients who are likely to benefit over medical therapy and experience outcomes compa- rable with surgical intervention, skill with the range of technology available (especially the treatment of chronic total occlusions), and careful surveillance for restenosis or new de novo disease that may limit long-term durability. 1 Technological improvements in the equipment used for endovascular revascularization have in- creased options for complex lesions once exclusively treated by open surgery. For this reason, older guidelines using length of dis- ease and its nature (i.e., stenotic vs. occlusive) to guide the mode of revascularization may no longer be valid. 2 The recent Trans-Atlantic Intersociety Consensus Document on Management of Peripheral Arterial Disease (TASC) advocates endovascular treatment for TASC A and B lesions in femoral artery. Moreover, unlike the TASC I consensus,the TASC II update al- lows for more flexibility in TASC C lesions with respect to primary treatment with endovascular therapy based on patient factors. There has been a marked increase in the use of endovascular interventions in the treatment of peripheral arterial disease, with femoropopliteal interventions accounting for more than 55% of cases. The femoropopliteal artery crosses two joint structures (hip and knee joints) and courses through the muscular adductor canal in the thigh, which places the artery at increased stress from torsion, bending as well as longitudinal and radial compression forces. Stents in the femoropopliteal system have historically been associated with increased rates of stent fracture, which is associated with high rates of restenosis and decreased primary patency rate during long-term follow-up. There is, therefore, a critical need for stent platforms with minimal-to-no risk of stent fracture. 3 With continuing advances in techniques and facilities, endovascular treatment enabled complex, long-segment occlu- sions to be revascularized successfully. Some reports showed satisfactory technical success rate and low perioperative compli- cations in long superficial femoral artery (SFA) lesions. How- ever, the follow-up time of these studies was short. 4 We report our experience in endovascular therapy of pe- ripheral artery disease with a long follow-up time. The aim of this study was to evaluate the technical success rates, primary patency, and complication for TASC C and D femoropopliteal and distal lesions treated by endovascular pro- cedure. In addition, the clinical outcomes were analyzed. PATIENT AND METHODS The study was performed in accordance with the Declara- tion of Helsinki-Good Clinical Practice guidelines and was Accepted for publication May 27, 2017. From the *Numune Training & Research Hospital, Ankara, Turkey; and †Yuksek Ihtisas Training & Research Hospital, Ankara, Turkey. Presented at the Annual Scientific Meeting of the International Society for Minimally Invasive Cardiothoracic Surgery, June 15–18, 2016, Montreal, QC Canada. Disclosure: The authors declare no conflicts of interest. Address correspondence and reprint requests to Serdar Gunaydin, MD, Department of Cardiovascular Surgery, Numune Training & Research Hospital, University of Health Sciences, Talatpasa Blvd, No 5, Altindag-Ankara, 06100, Turkey. E-mail: sgunaydin@isnet.net.tr. Copyright © 2017 by the International Society for Minimally Invasive Cardiothoracic Surgery ISSN: 1556-9845/17/1204–0287 ORIGINAL ARTICLE Innovations • Volume 12, Number 4, July/August 2017 287 Copyright © 2017 by the International Society for Minimally Invasive Cardiothoracic Surgery. Unauthorized reproduction of this article is prohibited.