Iliac Artery Angioplasty: Technique and Results

Abstract

Percutaneous angioplasty is widely used for the treatment of iliac artery occlusive disease. Access to the ipsi-lateral, or less commonly contralateral, common femoral artery is obtained under local anaesthesia; the lesion is crossed with a guidewire and dilated with an angioplasty balloon catheter. This technique yields excellent immediate results with very few complications. Stent placement is used in lesions not amenable to balloon angioplasty, in complications, and recurrences. Evidence suggests that balloon angioplasty is the procedure of choice for iliac artery occlusive lesions. Stent placement should be reserved for angioplasty failures. However, primary stent placement is indicated in total occlusions. Lesion morphology is an important determinant of immediate success and long-term patency. TASC lesions type A and B are best treated with angioplasty and stenting, while TASC lesions type C and D show better results with surgical treatment. The development of new stent designs may expand the indications of the percutaneous treatment.

Effectiveness and long-term outcomes of different crossing strategies for the endovascular treatment of iliac artery chronic Total occlusions

“…Retrograde crossing is the preferred strategy used by some operators, as it is straight, short, and easy to manipulate, yet it has the disadvantage that it usually involves advancing into the subintimal space, which is a difficult issue for perforating thickened aortic intima and causes serious complications owing to aortic dissection. Therefore, the subintimal approach is supposed to prevent dissection from extending to the level of the aortic bifurcation, and re-entry techniques are needed [ 9 ].…”

Effectiveness and Long-term Outcomes of Different Crossing Strategies for the Endovascular Treatment of Iliac Artery Chronic Total Occlusions

“…Retrograde crossing is the preferred strategy used by some operators, as it is straight, short, and easy to manipulate, yet it has the disadvantage that it usually involves advancing into the subintimal space, which is a di cult issue for perforating thickened aortic intima and causes serious complications owing to aortic dissection. Therefore, the subintimal approach is supposed to prevent dissection from extending to the level of the aortic bifurcation, and re-entry techniques are needed [9].…”

Endovascular Management of Flush Common Iliac Artery Occlusive Disease: Challenges and Solutions

“…8,16 Although using only retrograde ipsilateral femoral approach was preferred access used by Ballard et al, Sullivan et al, and Brountzos and Kelekis as it is short, straight, and successful in 80% of cases, yet it has several disadvantages that were mentioned by Thava et al, as it usually creates subintimal dissection which will be a problem in re-entry as thickened aortic intima heralds the re-entry and also dissection may reach to renal and lumbar causing serious effect. 2,13,17,18 Therefore, we prefer to better use of two accesses even in unilateral disease either contralateral femoral access or brachial access to do angiography and crossing the lesion, while ipsilateral retrograde femoral used to insert the stent as the end near origin of iliac artery will be deployed first allowing proper and precise insertion meanwhile allowing the usage of self-expandable stent with a great accuracy. In addition, advantages of using two accesses are to do angiography from contralateral approach allowing good planning of work and with the presence of bilateral access, it is easier to convert the procedure to kissing stents as required.…”

“…On the contrary, Brountzos and Kelekis, Lumsden et al, Criado et al, and Schneider advocated present dilatation. 18,[20][21][22][23] Present dilatation had several advantages. It facilitates the second femoral ipsilateral puncture and makes a smooth passage of stent without insult the plaque and allow better sizing of the stent and balloon needed.…”