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Iliac artery stenting in patients with poor distal runoff: Influence of concomitant infrainguinal arterial

Carlos H Timaran1, Takao Ohki, Nicholas J Gargiulo

  • 1Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467, USA. timaran1@msn.com

Journal of Vascular Surgery
|August 30, 2003
PubMed

Insights

Concomitant infrainguinal arterial reconstruction (CIAR) does not improve iliac artery stent patency in patients with poor distal runoff. These infrainguinal bypass procedures should be reserved for patients with limb-threatening ischemia.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Peripheral Artery Disease

Background:

  • Inadequate infrainguinal runoff is a known risk factor for iliac stent failure.
  • The impact of concomitant infrainguinal arterial reconstruction (CIAR) on iliac stent patency remains unclear.

Purpose of the Study:

  • To evaluate the influence of CIAR on the outcomes of iliac angioplasty and stenting (IAS) in patients with poor distal runoff.
  • To determine if combining IAS with CIAR improves iliac stent patency compared to IAS alone.

Main Methods:

  • A retrospective study of 68 IAS procedures (78 stents) in 62 patients with poor distal runoff (runoff score >=5) between 1996 and 2001.
  • Outcomes were analyzed using Kaplan-Meier and Cox proportional hazards models, adhering to SVS/AAVS reporting standards.
  • Patients were divided into two groups: IAS with CIAR (n=31) and IAS alone (n=37).

Main Results:

  • Patients undergoing IAS with CIAR had more extensive iliac artery disease (TASC type C lesions) and were older.
  • Primary iliac stent patency rates at 1, 3, and 5 years were not significantly different between the IAS with CIAR group (87%, 54%, 42%) and the IAS alone group (76%, 66%, 55%).
  • Performing CIAR did not impact primary iliac stent patency (RR 1.1, P=.81), but there was a trend towards improved limb salvage in the IAS with CIAR group (P=.07).

Conclusions:

  • In patients undergoing IAS for poor distal runoff, CIAR does not enhance iliac artery stent patency.
  • Infrainguinal bypass procedures should be considered for patients not improving clinically or those with limb-threatening ischemia.
  • The decision to perform CIAR should be based on clinical indication rather than solely on improving iliac stent patency.
Abstract

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