Percutaneous Treatment in Iliac Artery Occlusion: Long-Term Results

Abstract

We evaluated the long-term results of recanalization with primary stenting for patients with long and complex iliac artery occlusions. This was a retrospective nonrandomised study. Between 1995 and 1999, 138 patients underwent recanalization of an occluded iliac artery with subsequent stenting. Patency results were calculated using Kaplan-Meier analysis. The mean length of follow-up was 108 months. Variables affecting primary stent patency such as patient age; stent type and diameter; lesion site, shape, and length; Society of Cardiovascular and Interventional Radiology classification; total runoff score; Fontaine classification; and cardiovascular risk factors were analysed using Breslow test. These variables were then evaluated for their relation to stent patency using Cox proportional hazards test. Technical success was 99%. Primary patency rates were 90% (SE .024), 85% (SE .029), 80% (SE .034), and 68% (SE .052) at 3, 5, 7, and 10 years, respectively. Lesion site (p = 0.022) and stent diameter (p = 0.028) were shown to have a statistically significant influence on primary stent patency. Long-term results of iliac recanalization and stent placement were excellent, without major complications, even in highly complex vascular obstructions. A primary endovascular approach appears to be justified in the majority of patients as a less invasive alternative treatment to surgery. In any case, a first-line interventional approach should be considered in elderly patients or in patients with severe comorbidities.

Primary stent placement for iliac artery chronic total occlusions

“…Recent series of primary stent placement for CTOs reported the 2-year primary and secondary or assisted primary patency rates of 69%-93% and 85%-95%, respectively. [3][4][5][6][7][8][9][10][11][12] Our series demonstrated 2-year primary and assisted primary patency rates of 91% and 96%, at the high end of the range of recent reports. However, although our patency rates for primary stents placed for iliac CTOs were better than those reported for extra-anatomic bypasses, such as axillofemoral and femorofemoral bypasses, these patency rates were not better than the patency conventionally reported for aortobifemoral bypass.…”

“…Our technical success rate was 100%, which was similar to that in most previous reports (97%-99%). 11,12 However, most investigators report technical problems that occurred with guidewire traversal of CTOs; guidewire crossing of these extensive lesions is rendered very diffi cult by the long fi brous cap and heavy calcifi cations that are invariably present. 1,2 A retrograde, ipsilateral approach may be preferable in most cases, since the tip of the guidewire can often be forced through the necrotic core of the lesions.…”

“…The 5-year primary and assisted primary patency rates were 55%-85% and 66%-95%, while those at 10 years was 68% (Table 2). 4,[7][8][9][10]12 Primary patency rates of aortobifemoral bypass for patients with claudication were reported to be 91.0% and 86.8% at 5 and 10 years, respectively, while 87.5% and 81.8% for patients with critical limb ischemia. 25 To date, the long-term durability appears to be better in aortobifemoral bypass than in primary stent placement, but it is highly likely that during the next few years endovascular techniques will be further refi ned, thereby leading an improved longterm durability.…”

“…3-12 One of the most recent reports demonstrated that technical success was 99%, and primary patency rates were 90%, 85%, 80%, and 68% at 3, 5, 7, and 10 years, respectively. 12 Motivated by these newer reports of excellent results, primary stent placement is increasingly referred for balloon angioplasty or bypass surgery for arterial CTOs in Japan.…”

Comparison of Clinical outcomes of Infragenicular Angioplasty between diabetic and non-diabetic patients with Peripheral Arterial Occlusive Disease

“…The 3-year primary patency rates in PTA group alone were less than 60% [31,32] ; while primary patency rates in PTA plus stenting group reached up to 90% [33][34][35]. Bosch and colleagues [36] found that the technical success rate of iliac angioplasty plus stenting was higher than that in PTA group alone but without statistically significant difference.…”