Long-term Cardiovascular Morbidity, Mortality, and Reintervention after Endovascular Treatment in Patients with Iliac Artery Disease: The Dutch Iliac Stent Trial Study

Klein, Willemijn M.; Graaf, Yolanda van der; Seegers, J.; Moll, Frans L.; Mali, Willem P.Th.M.

doi:10.1148/radiol.2322030725

Cited by 72 publications

(29 citation statements)

References 34 publications

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“…At a mean follow-up of 5.6 years, there was no difference in repeat interventions between the 2 groups, with a target-vessel revascularization rate of 18% in the primary stent group and 20% in the provisional stent group. 36 This approach is reasonable in relatively short, nonocclusive lesions but has not been tested in more complex subsets.…”

Section: Patient Selection and Outcomes Aortoiliac Diseasementioning

confidence: 99%

Endovascular Therapies for Peripheral Arterial Disease

2007

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Abstract-Peripheral arterial disease is one manifestation of systemic atherosclerosis. The prevalence of peripheral arterial disease increases with the age of the population. It is important to remember the significant association of coincident coronary artery disease, which is the major cause of mortality in these patients. (Figure 1). 1,2 It is important to remember the significant association of coincident coronary artery disease and cerebrovascular disease in these patients, because it represents the major cause of major morbidity and mortality in the PAD population. 3 Remarkable technological advances in the past decade, along with patient preference, have shifted revascularization strategies from traditional open surgical approaches toward lower-morbidity percutaneous endovascular treatments. Catheter-based revascularization of the lower extremities was first performed by Charles Dotter 4 and advanced by Andreas Gruentzig, who employed then newly developed inflatable balloon catheters that could dilate vascular stenoses. 5 The availability of stents, more than any other advance, has fueled the growth of catheterbased procedures by improving the safety, durability, and predictability of percutaneous revascularization.Endovascular therapy offers several distinct advantages over open surgical revascularization for selected lesions. 6,7 It is performed with local anesthesia, which enables the treatment of patients who are at high risk for general anesthesia. The morbidity and mortality from catheter-based therapy is extremely low, especially compared with open surgical revascularization. After successful percutaneous revascularization, patients are ambulatory on the day of treatment, and unlike after vascular surgery, they can often return to normal activity within 24 to 48 hours of an uncomplicated procedure. Endovascular therapies generally do not preclude or alter subsequent surgery and may be repeated if necessary.Multiple specialties, including interventional cardiology, have contributed to the advancement of the field of peripheral vascular intervention over the past several decades. 8 The recognition of an unmet need for a trained cadre of clinicians to care for patients with PAD prompted the development of a core curriculum document (COCATS-11) 9 and a multispecialty societal competency statement. 10 The American Heart Association and American College of Cardiology have published guidelines and recommendations for the diagnosis and treatment of PAD. 2 Improved patient and physician awareness of PAD and the availability of high-quality noninvasive diagnostic imaging have increased the number of patients seeking treatment for PAD. Diagnostic Evaluation Noninvasive AssessmentThe initial assessment should include a physical examination, with the patient's shoes and socks removed, to look for signs of acute or chronic peripheral ischemia and distal embolization and to determine the status of the peripheral pulses. The abdomen is examined for evidence of an aortic aneurysm, and blood pressure should be meas...

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Section: Patient Selection and Outcomes Aortoiliac Diseasementioning

confidence: 99%

Endovascular Therapies for Peripheral Arterial Disease

2007

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“…By employing a provisional stenting strategy in the iliac artery, stent placement was avoided in 63% of the lesions. After 5-years of follow-up there was no group difference in patency rates, ABI, and quality of life [23].…”

Section: Angioplasty and Stentingmentioning

confidence: 74%

SCAI expert consensus statement for aorto‐iliac arterial intervention appropriate use

Klein

Feldman

Aronow

et al. 2014

Cathet Cardio Intervent

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Aorto‐iliac arterial occlusive disease is common and may cause a spectrum of chronic symptoms from intermittent claudication to critical limb ischemia. Treatment is indicated for symptoms that have failed lifestyle and medical therapies or occasionally to facilitate other interventional procedures such as TAVR and/or placement of hemodynamic assist devices. It is widely accepted that TASC A, B, and C lesions are best managed with endovascular intervention. In experienced hands, most TASC D lesions may be treated by endovascular methods, and with the development of chronic total occlusion devices, many aorto‐iliac occlusions may be recanalized safely by endovascular means. Interventional cardiologists should be well versed in the anatomy, as well as the treatment of aorto‐iliac disease, given their need to traverse these vessels during transfemoral procedures. Overall, aorto‐iliac occlusive disease is more commonly being treated with an endovascular‐first approach, using open surgery as a secondary option. This document was developed to guide physicians in the clinical decision‐making related to the contemporary application of endovascular intervention among patients with aorto‐iliac arterial disease. © 2014 Wiley Periodicals, Inc.

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“…We presented a complete spectrum with both subjective and objective results. Data about cardiovascular morbidity and mortality in these patients have been published before (6). Some studies about endovascular treatment of the iliac arteries with a follow-up of 4 years or longer have been published (11)(12)(13)(14)(15)(16).…”

Section: Discussionmentioning

confidence: 99%

Dutch Iliac Stent Trial: Long-term Results in Patients Randomized for Primary or Selective Stent Placement

Seeger¹

2008

Yearbook of Surgery

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Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Klein, W. M., van der Graaf, Y., Seegers, J., Spithoven, J. H., Buskens, E., van Baal, J. G., ... Mali, W. P. T. M. (2006). Dutch iliac stent trial: Long-term results in patients randomized for primary or selective stent placement. RADIOLOGY, 238(2), 734-744. CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Purpose:To determine long-term results of the prospective Dutch Iliac Stent Trial. Materials and Methods:The study protocol was approved by local institutional review boards. All patients gave written informed consent. Two hundred seventy-nine patients (201 men, 78 women; mean age, 58 years) with iliac artery disease were randomly assigned to undergo primary stent placement (143 patients) or percutaneous transluminal angioplasty (PTA) with selective stent placement in cases in which the residual mean pressure gradient was greater than 10 mm Hg across the treated site (136 patients). Before and at 3, 12, and 24 months and 5-8 years after treatment, all patients underwent assessment, which included duplex ultrasonography (US), ankle-brachial index (ABI) measurement, Fontaine classification of symptoms, and completion of the Rand 36-Item Health survey for quality-of-life assessment. Treatment was considered successful for symptoms if symptoms increased at least one Fontaine grade, for ABI if ABI increased more than 0.10, for patency if peak systolic velocity ratio at duplex US was less than 2.5, and for quality of life if the RAND 36-Item Health Survey score increased more than 15 points. Effects of both treatments on symptoms, quality of life, patency, and ABI were compared by using survival analyses. Results:Patients who underwent PTA and selective stent placement had better improvement of symptoms (hazard ratio [HR], 0.8; 95% confidence limits [CLs]: 0.6, 1.0) than did patients treated with primary stent placement, whereas ABI (HR, 0.9; 95% CLs: 0.7, 1.3), iliac patency (HR, 1.3; 95% CLs: 0.8, 2.1), and score for quality of life for nine survey dimensions did not support a difference between treatment groups. Conclusion:Patients treated with PTA and selective stent placement in the iliac artery had a better outcome for symptomatic success compared with patients treated with primary stent placement, whereas data about iliac patency, ABI, and quality of life did not support a difference between groups.RSNA, 2005

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Long-term Cardiovascular Morbidity, Mortality, and Reintervention after Endovascular Treatment in Patients with Iliac Artery Disease: The Dutch Iliac Stent Trial Study

Abstract: No difference was found in the number of reinterventions between the two treatment groups 5 years after treatment. Patients with iliac artery disease are at high risk of cardiovascular morbidity and mortality.

Cited by 72 publications

References 34 publications

Endovascular Therapies for Peripheral Arterial Disease

Endovascular Therapies for Peripheral Arterial Disease

SCAI expert consensus statement for aorto‐iliac arterial intervention appropriate use

Dutch Iliac Stent Trial: Long-term Results in Patients Randomized for Primary or Selective Stent Placement

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