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Percutaneous interventions for treatment of iliac artery stenoses and occlusions
1Department of Diagnostic and Interventional Radiology, Klinikum Ingolstadt, Krumenauerstrasse 25, 85049 Ingolstadt, Germany.
Insights
Balloon angioplasty is a safe and effective treatment for iliac artery interventions. Intraarterial pressure monitoring helps assess success, with stenting considered for complications or inadequate results.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Procedures
Background:
- Balloon angioplasty is the primary method for percutaneous iliac artery interventions due to its simplicity, cost-effectiveness, and safety.
- Adequate hemodynamic results post-angioplasty generally ensure acceptable patency.
- Intraarterial pressure monitoring is crucial for evaluating the success of these interventions.
Purpose of the Study:
- To review the current techniques and outcomes of percutaneous interventions in the iliac arteries.
- To discuss the role of balloon angioplasty, stenting, and other modalities in managing iliac artery diseases.
- To highlight challenges and considerations in treating chronic iliac occlusions and in-stent stenosis.
Main Methods:
- Review of existing literature on percutaneous iliac artery interventions.
- Discussion of techniques including balloon angioplasty, stenting, thrombolysis, atherectomy, and stent grafts.
- Analysis of indications for different treatment modalities based on lesion characteristics and outcomes.
Main Results:
- Balloon angioplasty alone can achieve acceptable results, but stenting may be necessary for dissections or inadequate luminal gain.
- Percutaneous treatment of chronic iliac occlusions is technically demanding, with various approaches described.
- Directional atherectomy or balloon dilatation is recommended for in-stent stenosis; stent grafts are reserved for rare complications.
Conclusions:
- Balloon angioplasty remains a cornerstone of iliac artery percutaneous intervention, supported by pressure monitoring.
- Stenting is often employed adjunctively or for specific challenging lesions like chronic occlusions and in-stent stenosis.
- While stent grafts have a role in rare complications, their benefit in atherosclerotic iliac disease requires further investigation.
Abstract:
Balloon angioplasty is still the main workhorse for percutaneous interventions in the iliac arteries. It is simple to perform, cost-effective, and remarkably safe. If an adequate hemodynamic result has been achieved, patency is acceptable. To monitor the quality of success, intraarterial pressure monitoring is an important tool. Balloon angioplasty may be followed by stent insertion in case of insufficient luminal gain after inadequate balloon angioplasty or occurrence of significant dissection. Percutaneous treatment of chronic iliac occlusions is technically challenging. For chronic occlusions (duration exceeding 3 months), balloon angioplasty alone, thrombolysis with subsequent balloon angioplasty, and elective stenting or mechanical passage of the occlusion followed by primary stent implantation have been described as alternative techniques. In case of in-stent stenosis, directional atherectomy or balloon dilatation is recommended. Stent grafts allow percutaneous exclusion of isolated iliac aneurysms, iatrogenic perforation, rupture, and arteriovenous fistulas, but these cases are rare. Some authors increasingly favor the use of endoluminal graft systems for treating atherosclerotic disease in iliac arteries, but insufficient data are available to prove the benefit of stent grafts in patients with atherosclerotic disease.