Transluminal angioplasty of complete iliac obstructions

Colapinto, Ronald F.; Stronell, RD; Johnston, WK

doi:10.2214/ajr.146.4.859

Cited by 92 publications

(25 citation statements)

References 1 publication

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“…The recanalization of the iliac occlusions is still debated, even though it reached a primary technical success in the percutaneous approach to iliac occlusions with PTA plus stenting close to 80% (9,13,14). Vorwerk et al, without performing the thrombolysis, reported a success in 81% of cases in terms of passing through the occlusion (9).…”

Section: Discussionmentioning

confidence: 99%

Thrombolysis during the endovascular treatment of iliac artery occlusions

Taddei

Tamellini²,

Faccioli³

et al. 2009

Diagn Interv Radiol

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84C urrently the number of aortofemoral bypasses performed for iliac occlusive arterial pathology is decreasing (1-4). The causes of this turnaround are the increase of the patients' mean age and the increased frequency of concurrent pathologies. Moreover, surgery, which for a long time has been considered as the treatment of choice for this pathology, has almost completely been replaced by less invasive methodologies such as endovascular treatments (5-9). The role of thrombolysis to treat the iliac arterial occlusive pathology on an atherosclerotic basis during endovascular surgery is controversial. Although comparing experiences is difficult, the results of pharmacologic thrombolysis to treat iliac arterial obstructions with regard to the different methodologies of treatment, to the drugs used and to other nonstandardized variables seem encouraging (8). The first experiences with fibrinolytic therapy made us think it was unlikely that thrombolytic occlusions which had been present for longer than 1-2 weeks would adequately respond to these treatments. On the contrary, it was proved that injections of streptokinase or urokinase-type plasminogen activator (uPA) through the thrombus could also cause complete fibrinolysis in chronic occlusions (8). Recent thrombi (<15 days) are more sensitive to lysis, as shown by data from post-angioplasty thrombolysis (2, 5, 10). It is also true, however, that remarkable results may be achieved by using only percutaneous treatment angioplasty (PTA) associated with the stent technique (7).The purpose of this study was to assess the possible therapeutic advantage of thrombolysis prior to recanalization of iliac occlusions with PTA and stenting. Materials and methodsWe retrospectively evaluated 28 cases of iliac occlusions treated in 26 patients (in two cases there was a re-occlusion) over a six-year period. Our cases did not have contraindications for thrombolysis. No patients were diabetic. The presumed etiologies for the iliac occlusions were plaque thrombosis for acute patients and chronic atherosclerotic disease for chronic patients. Absolute contraindications were established such as cerebrovascular event (including transient ischemic attacks within last 2 months), active bleeding diathesis, recent gastrointestinal bleeding (<10 days), neurosurgery within last 3 months, and trauma within last 3 months (10, 11); relative major contraindications were cardiopulmonary resuscitation within last 10 days, major nonvascular surgery or trauma within last 10 days, uncontrolled hypertension (180 mmHg systolic or 110 mmHg diastolic), puncture of non-compressible vessel, intracranial tumor, and eye surgery; minor contraindications were hepatic failure, particularly those with coagulopathy, bacterial endocarditis, pregnancy, and hemorrhagic retinopathy (10, 11). INTERVENTIONAL RADIOLOGY ORIGINAL ARTICLE Thrombolysis during the endovascular treatment of iliac artery occlusionsGiuseppe Taddei, Paolo Tamellini, Faccioli Niccolo, Iannello Antonio PURPOSEThe purpose of this study was to assess...

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Section: Discussionmentioning

confidence: 99%

Thrombolysis during the endovascular treatment of iliac artery occlusions

Taddei

Tamellini²,

Faccioli³

et al. 2009

Diagn Interv Radiol

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“…The success of this procedure is in many authors' opinion strongly dependent on the length of the occlusion. Colapinto et al [4] reported that the longer the occlusion the lower the success rates of recanalization, and presented a success rate of 92% for occlusions shorter than 5 cm and a 70% success rate in the recanalization of those longer than 5 cm.…”

Section: Discussionmentioning

confidence: 99%

“…Until recently, long occlusions of the iliac arteries were not a generally accepted indication for percutaneous treatment and especially for complex lesions as well as long occlusions vascular surgery is still considered as the treatment of choice and is more commonly used [2,3]. Balloon dilatations of iliac occlusions have a technical failure rate as high as 22% [4] and a less favorable long-term outcome than occurs with dilation of iliac stenoses [4,5]. Because of the relatively high rate of complications, owing to dislodgment of thromboembolic material and distal embolization, thrombolytic therapy before balloon angioplasty has been advocated [6].…”

Section: Introductionmentioning

confidence: 99%

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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“…Several studies have compared the outcomes of percutaneous transluminal angioplasty (PTA) with provisional stenting to primary stenting for both iliac stenosis and occlusions [20][21][22] The Dutch iliac stent trial found that PTA with provisional stenting (for a residual gradient of >10 mmHg) had similar results to primary stenting [9] However, this study excluded patients with more complex lesions (lesions >10 cm or CTO's >5 cm). By employing a provisional stenting strategy in the iliac artery, stent placement was avoided in 63% of the lesions.…”

Section: Angioplasty and Stentingmentioning

confidence: 99%

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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Transluminal angioplasty of complete iliac obstructions

Cited by 92 publications

References 1 publication

Thrombolysis during the endovascular treatment of iliac artery occlusions

Thrombolysis during the endovascular treatment of iliac artery occlusions

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

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

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