Predictors of Long-Term Results After Treatment of Iliac Artery Obliteration by Transluminal Angioplasty and Stent Deployment

Funovics, Martin; Lackner, Birgit; Cejna, Manfred; Peloschek, Philipp; Sailer, Johannes; Philipp, M.; Maca, Thomas; Ahmadi, A; Minar, Erich; Lämmer, Johannes

doi:10.1007/s00270-002-1877-1

Cited by 36 publications

(13 citation statements)

References 22 publications

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“…However, rapid advances in endovascular surgery have significantly changed the patterns of vascular reconstruction. Recent studies on stenting for iliac artery stenosis and occlusion show 3-year primary patency rates of 69% to 92% and 64% to 90%, respectively [18][19][20][21][22] , whereas the 2-year primary patency rate of stenting for superficial femoral artery stenosis or occlusion is reported to be 60% to 69%. [23][24][25][26] However, endovascular surgery has less favorable outcomes for some lower extremity arteries, such as the common femoral and deep femoral arteries.…”

Section: Discussionmentioning

confidence: 99%

Hybrid Endarterectomy and Endovascular Therapy in Multilevel Lower Extremity Arterial Disease Involving the Femoral Artery Bifurcation

Zou

Xia

Yang

et al. 2012

International Surgery

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The objective of this study was to evaluate the feasibility and efficacy of hybrid therapy (combined endarterectomy-endovascular) in patients with complex peripheral multifocal steno-obstructive vascular disease involving the femoral artery bifurcation. Forty-one combined procedures were performed on 40 patients. Although the common femoral artery was usually treated with endarterectomy, endoluminal procedures were performed proximally in 12 patients (group 1), distally in 18 patients (group 2), and both upward and downward in 11 patients (group 3). Patients underwent clinical assessment and anklebrachial index measurement thereafter. Primary, assisted-primary, and secondary patency rates at 24 months were 59%, 66%, and 72%, respectively. Primary patency rates were lower in group 3 compared with groups 1 and 2 (P = 0.015). The limb salvage rate was 86.4% at the end of the follow-up period. Hybrid procedures provide feasible and effective treatment management of selected patients with multilevel lower extremity arterial disease involving the femoral artery bifurcation.Key words: Endarterectomy -Interventional radiography -Arteriosclerosis obliteransFemoral artery T he indications for the endovascular treatment of peripheral arterial disease have rapidly increased since the introduction of percutaneous transluminal angioplasty (PTA) and stenting. 1,2 The advantages of the endovascular approach include lower periprocedural morbidity and mortality. Short-term data from Bypass versus Angioplasty trials in Severe Ischemia of the Leg (BASIL) have confirmed this, with similar clinical outcome for the surgical and endovascular approach. Considerable progress has also been made in the endovascular treatment of infrapopliteal arterial occlusion. One study has demonstrated that infrapopliteal angioplasty is a reasonable primary treatment for critical limb ischemia patients with TransAtlantic InterSociety Consensus (TASC) A, B, or C lesions. 4 Due to the multilevel nature of peripheral arterial disease, iliac or femoral lesions accompanied by the femoral artery bifurcation (FB) disease are frequently observed. 5,6 Endovascular surgery is poorly suited to treating lesions in the FB because they are bulky and eccentric. In addition, the location of the lesions makes ipsilateral access difficult and stent placement impossible. As with the common femoral artery, the deep femoral artery is not generally favorable for endovascular surgery because it usually has either an orifice lesion involving the FB or a diffuse lesion along the length of the artery, which is often into its secondary and tertiary branches.Simultaneous hybrid endovascular and open lower extremity arterial reconstructive procedures have the advantage of eliminating the need for major surgery and avoiding separate staged interventions and their associated morbidity. Recently, several investigators have published results on several types of combined treatments for various patterns of iliac, femoral, and infrapopliteal diseases with promising outcomes.7-14 Mos...

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Section: Discussionmentioning

confidence: 99%

Hybrid Endarterectomy and Endovascular Therapy in Multilevel Lower Extremity Arterial Disease Involving the Femoral Artery Bifurcation

Zou

Xia

Yang

et al. 2012

International Surgery

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“…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.…”

Section: Discussionmentioning

confidence: 49%

“…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.…”

Section: Discussionmentioning

confidence: 96%

Primary stent placement for iliac artery chronic total occlusions

Kondo¹,

Dardik

Muto

et al. 2010

Surg Today

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“…ASA was applied by several authors in various dosages (range 100-500 mg daily) in combination with either 250 mg ticlopidine on a lifetime basis, 225 mg dipyridamole for 3-6 months or 250 mg ticlopidine for 3 months [1,15,24]. Funovics et al [17] changed their postinterventional medication regimen from 100 mg ASA daily on a lifetime basis to 75 mg clopidogrel daily later in their study. The Antiplatelet Trialists' Collaboration reviewed 189 controlled studies and found that ASA given prophylactically lowers the risk of vascular events as much as 25% [26].…”

Section: Discussionmentioning

confidence: 97%

“…Müller-Leisse et al [15] experienced ten complications (43.5%), 6/10 embolic events, after recanalization of 23 occlusions with a mean length of 12 cm. Funovics et al [17] reported complications in seven of 78 patients (9%), with a mean lesion length of 6.2 cm.…”

Section: Discussionmentioning

confidence: 98%

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

et al. 2005

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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.

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Predictors of Long-Term Results After Treatment of Iliac Artery Obliteration by Transluminal Angioplasty and Stent Deployment

Cited by 36 publications

References 22 publications

Hybrid Endarterectomy and Endovascular Therapy in Multilevel Lower Extremity Arterial Disease Involving the Femoral Artery Bifurcation

Hybrid Endarterectomy and Endovascular Therapy in Multilevel Lower Extremity Arterial Disease Involving the Femoral Artery Bifurcation

Primary stent placement for iliac artery chronic total occlusions

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

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