Percutaneous laser-assisted recanalization of long chronic iliac artery occlusions: primary and mid-term results
Jörn O Balzer1, Verena Gastinger, Axel Thalhammer
1Department of Diagnostic and Interventional Radiology, University Clinic, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany. j.o.balzer@em.uni-frankfurt.de
Insights
Percutaneous excimer-laser-assisted recanalization effectively treats long chronic iliac artery occlusions. This minimally invasive approach shows high success and patency rates, improving patient outcomes with mid-term results comparable to shorter blockages.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Therapy
Background:
- Chronic iliac artery occlusions pose significant challenges in peripheral artery disease management.
- Percutaneous interventions for long occlusions have historically yielded suboptimal results.
Purpose of the Study:
- To evaluate the primary and mid-term outcomes of excimer-laser-assisted recanalization for long chronic iliac artery occlusions.
- To assess the technical success, clinical improvement, and patency rates of this endovascular technique.
Main Methods:
- A cohort of 43 patients with 46 chronic iliac artery occlusions underwent laser-assisted angioplasty and stenting.
- Occlusion length averaged 57.1 mm; follow-up extended up to 4 years.
- Patency was assessed using ankle-brachial index (ABI) and duplex ultrasound.
Main Results:
- Primary technical success rate was 95.3% with a 6.9% major complication rate.
- Clinical improvement (Rutherford guidelines) was observed in 97.6% of patients.
- Overall primary patency was 86.1%, with a secondary patency of 95.4% after reintervention.
Conclusions:
- Excimer-laser-assisted recanalization is a safe and effective treatment for long chronic iliac artery occlusions.
- The procedure achieves high technical success and excellent mid-term patency rates.
- Outcomes are comparable to those reported for shorter iliac artery stenoses, offering a viable alternative to surgical bypass.
Abstract:
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.
