Percutaneous laser-assisted recanalization of long chronic iliac artery occlusions: primary and mid-term results

Abstract

We report the primary and mid-term outcome of patients with long chronic iliac artery occlusions after percutaneous excimer-laser-assisted interventional recanalization. Between 2000 and 2001, 43 patients with 46 chronic occlusions of either the common iliac artery (n=27), the external iliac artery ( n=13) or both (n=3) underwent laser-assisted percutaneous transluminal angioplasty and implantation of stents. The average length of the occlusion was 57.1+/-26 mm. After laser-assisted angioplasty and implantation of a total of 60 stents, the patients were followed up for up to 4 years. Patency rates were analyzed by ankle-brachial index (ABI) measurement and duplex ultrasound. The primary technical success rate was 95.3%, with a major complication rate of 6.9%. Clinical improvement as categorized by the Rutherford guidelines could be observed in 97.6% of cases. The ABI of all patients improved from an average of 0.46+/-0.08 before intervention to 0.97+/-0.13 at the end of the follow-up period. The overall primary patency rate was 86.1%. Four reinterventions were successful (secondary patency rate 95.4%). The mid-term results of the percutaneous recanalization of iliac artery occlusions with primary and secondary patency rates of 86.1 and 95.4% are similar to those of the treatment of short stenoses.

Efficacy of stent-supported subintimal angioplasty in the treatment of long iliac artery occlusions

“…A small study with 43 patients demonstrated feasibility of laser angioplasty in chronic iliac occlusions with a technical success rate of 95.3%. 26 However, the efficacy of laserassisted recanalization in iliac occlusions needs to be validated in larger studies.…”

Heavily calcified chronic total occlusion of common iliac artery successfully treated with Tornus microcatheter and rotational atherectomy

“…1 Diffuse severe calcification, which may often be present in patients receiving long-term hemodialysis, 4 may be one of causes of procedural failure after successful guidewire passage, although it is rare. These limitations, which are common in percutaneous coronary intervention (PCI), have led to the development of new devices.…”

“…1 One of the causes of failure is the inability to cross the lesion with a balloon angioplasty catheter. The use of the Tornus microcatheter (Asahi Intecc, Aichi, Japan) to overcome this limitation has recently been approved by the United States Food and Drug Administration (Fig 1).…”

Surgical thrombectomy in horses with aortoiliac thrombosis: 17 cases

“…No association could be made between the duration or the severity of the clinical signs and the clinical outcome. The success of this procedure is in the authors' opinion, dependent on the length of the occlusion in which the thrombus is adhered to the arterial wall, as described in human literature (Colapinto et al 1986;Balzer et al 2006). It seems that intraoperatively if the thrombus is only loosely adhered to the arterial wall the prognosis is more favourable than if the thrombus adheres tightly.…”

“…With the repeated use of the Fogarty catheter, which tears the thrombus out of the artery, damaging of the arterial wall occurs. Improvement of the technique might be obtained by the use of an excimer laser for debulking the thrombus, and stent implantation (Balzer et al 2006), reducing the chance of restenosis. However, in human patients, a 3 mm laser canal is created and then the implant is inserted after balloon dilation (Balzer et al 2006).…”