Primary stent placement for iliac artery chronic total occlusions

Abstract

Our results indicate that primary stent placement is a safe and effective treatment for iliac CTOs. However, major complications, including distal embolization and iliac artery rupture, remain a significant problem, and caution should therefore be exercised when performing this technique for iliac CTOs.

Subintimal angioplasty of chronic total occlusion in iliac arteries: A safe and durable option

“…10 Kondo reported a 2-year primary patency rate of 90% for primary stenting of iliac artery CTOs. 11 Both studies do not report the numbers at risk in their Kaplan-Meier analysis, and keep in mind, these two studies examine different populations from our study, likely accounting for the differences in patency. In a similar fashion, direct comparison with aortobifemoral bypass is not valid, as our practice's aortobifemoral bypass patients are now mostly a historical cohort.…”

“…Technical success in revascularization of CTOs in contemporary series has been reported between 92% and 99%. 10,11 The technical failures in this study were all due to failed re-entry. For a portion of this study, no re-entry device was commercially available, contributing to this lower technical success rate.…”

“…2,7,10,11 Most of these series utilize intraluminal techniques to traverse the iliac obstruction, with a minority of lesions managed with SIA. In this study of iliac artery CTO managed exclusively with SIA, 34.7% of the lesions were graded TASC D. Although a technical success rate of 83.5% was seen in this study, the majority of these lesions were TASC C and D (61.4%), and all of these lesions were iliac artery CTOs.…”

Preferential Use of Infrapopliteal Angioplasty for Critical Limb Ischemia: Vascular Surgeons' Perspective

“…Iliac artery lesions were treated with primary stenting, while superficial femoral artery lesions were preferentially treated with balloon angioplasty and selective stenting. [8][9][10] Stents were placed in superficial femoral artery lesions only when residual stenosis and flow-limiting dissections were noticed after balloon angioplasty. Rigid balloon expandable stents such as Palmaz (Cordis Endovascular) and Express LD (Boston Scientific) were used for most common iliac artery lesions, and flexible self-expanding stents such as SMART (Cordis Endovascular) and Luminexx (BARD, Murray Hill, New Jersey) for most external iliac or superficial femoral artery lesions.…”

Advanced Age and Disease Predict Lack of Satisfaction After Iliac Stent Placement

“…These pioneering results have been validated by large contemporary series [5,6]. Not surprisingly, indications now have expanded from simple stenoses to include advanced disease such as complex stenosis, as well as occlusions [7-9]. With 96 percent technical success, perioperative morbidity <10 percent and 96 percent 3-year and 85 percent 5-year patency endovascular techniques are now the most common first approach to treat iliac artery disease [6,10,11].…”