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Aortoiliac insufficiency: long-term experience with stent placement for treatment
Timothy P Murphy1, Nikki S Ariaratnam, Wilfred I Carney
1Division of Vascular and Interventional Radiology, Department of Diagnostic Imaging, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903, USA.
Insights
Aortoiliac stent placement offers a durable and low-risk solution for chronic lower-extremity ischemia. Long-term outcomes show significant patency and symptom relief in patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Therapy
Background:
- Chronic lower-extremity ischemia significantly impacts patient quality of life.
- Endovascular interventions are increasingly utilized for peripheral artery disease.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of aortoiliac stent placement.
- To report outcomes in patients with chronic lower-extremity ischemia.
Main Methods:
- Retrospective analysis of 365 patients undergoing aortoiliac stent placement for chronic lower-extremity ischemia.
- 505 arterial lesions (occlusions and stenoses) were treated between 1992 and 2001.
- Follow-up extended up to 105 months (mean 33 months).
Main Results:
- High technical success rate (98%) with significant improvement in ankle-brachial index.
- Major complications occurred in 7% of patients; 30-day mortality was 0.5%.
- Eight-year primary patency was 74%, with 74% of limbs remaining asymptomatic.
Conclusions:
- Aortoiliac stent placement is a durable revascularization option for chronic lower-extremity ischemia.
- The procedure demonstrates a favorable risk-benefit profile for selected patients.
- Long-term follow-up confirms sustained clinical improvement and limb salvage.
Purpose:
To establish and report the authors' experience with the long-term outcomes of aortoiliac stent placement for treatment of chronic lower-extremity ischemia.
Materials And Methods:
Stents were placed in 505 arterial segment lesions in 365 patients who presented with symptoms of chronic leg ischemia between February 1992 and March 2001. The 505 treated lesions were 88 occlusions and 417 stenoses. Indications for stent placement were claudication in 312 (62%), rest pain in 107 (21%), ulcer in 67 (13%), and gangrene in 19 (4%) arterial segments. Patients were followed up for up to 105 months (mean, 33 months +/- 27 [SD]).
Results:
Hemodynamic success was achieved in 484 (98%) of the 496 limbs for which postprocedural translesion pressure gradients were available. Mean ankle-brachial indexes improved from 0.53 +/- 0.25 to 0.79 +/- 0.23 (P <.001). Major complications were seen in 24 (7%) patients. Two patients (0.5%) died within 30 days after stent placement. Twenty (6%) of 355 patients underwent aortic or iliac bypass surgery during the follow-up period. Eight years after stent placement, primary patency was 74%; primary assisted patency, 81%; and secondary patency, 84%. Variables associated with better patency included stenosis (rather than occlusion), shorter lesion length, older age, and limb-threatening ischemia. At the last follow-up examination, 74% of the 466 limbs for which follow-up clinical status data were available were asymptomatic, 22% were associated with claudication, 3% were associated with rest pain, and 1% were associated with ischemic tissue loss. Five patients underwent amputation on the ipsilateral side after stent placement.
Conclusion:
Findings from long-term experience with aortoiliac stent placement for treatment of chronic lower-extremity ischemia confirmed the procedure to be a durable, low-risk revascularization option.
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