Stent placement in short unilateral iliac occlusion. Technique and 24-month results

To determine the success rate and 24-month follow-up results of primary stent implantation for reconstruction of unilateral short iliac occlusion involving the aortic bifurcation.

In 90 patients attempts of percutaneous transluminal recanalization of a short unilateral occlusion of the iliac arteries were performed. In 72/90 patients, the treatment was successful. Stent implantation was performed after recanalization in all 72 patients. Pre-interventional angiography of successfully treated patients showed unilateral occlusions and contralateral stenosis in 34/72 patients. In 38/72 patients unilateral occlusion without contralateral stenosis was diagnosed. The recanalization of the common iliac artery obstructions were performed with a guidewire and excimer laser angioplasty. Totally 152 stents were used for the treatment of iliac occlusion. Standardized treadmill testing and color-coded Doppler ultrasound were performed before treatment and during the follow-up.

In all patients, stents were placed successfully; 5 major and 7 minor complications were observed. A clinical improvement of +2 to +3 according to the American Heart Association criteria was observed in 62 and 10 patients, respectively. Angiographic control was performed after 1-30 months. The primary angiographic patency rate was 83.1%. Angiography revealed significant restenoses in 4 patients successfully treated with transluminal angioplasty, and re-occlusion in 6 patients which were referred to surgery. The patency rate after 24 months was 90.0%.

Primary stent implantation is an effective treatment for short iliac obstructions and represents a true endovascular alternative to surgery.