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Long-term results of primary stenting for long and complex iliac artery occlusions
A De Roeck1, J M H Hendriks, F Delrue
1Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium.
Insights
Iliac artery recanalization with stenting shows excellent long-term patency and can be a viable alternative to surgical bypass for high-risk patients with complex occlusions.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Endovascular Therapy
Background:
- Iliac artery occlusions present significant challenges in vascular reconstruction.
- Complex and long occlusions often necessitate advanced endovascular techniques.
Purpose of the Study:
- To assess the long-term efficacy and safety of recanalization and primary stenting for long, complex iliac artery occlusions.
- To compare endovascular outcomes with traditional surgical bypass options.
Main Methods:
- Retrospective analysis of 38 patients with TASC B, C, and D iliac artery occlusions treated between 1996 and 2004.
- Kaplan-Meier analysis was used to determine patency rates with a mean follow-up of 26 months.
- Patients with Fontaine stages 2B, 3, and 4 were included, with two receiving pre-procedural thrombolysis.
Main Results:
- Technical success rate was 97.4% with a 30-day mortality of 2.7%.
- Primary patency rates were 94% at 1 year, 89% at 3 years, and 77% at 5 years.
- Secondary patency remained high at 100% at 1 year and 94% at 3 years, with a low complication rate of 5.4%.
Conclusions:
- Iliac recanalization and stenting yield excellent long-term results for complex occlusions.
- This endovascular approach offers a safe and effective alternative to surgical bypass, particularly in high-risk patient populations.
- Successful technical outcomes are crucial for achieving sustained patency and minimizing complications.
Objectives:
To evaluate the long-term results of recanalization with primary stenting for long and complex iliac artery occlusions.
Design:
Retrospective non-randomized study.
Methods:
Between 1996 and 2004, 38 patients underwent recanalization of an occluded iliac artery with subsequent stenting for TASC B lesions in 12 patients, TASC C in 10 and TASC D in 16. Thirty-one patients had Fontaine stage 2 B, four patients had stage 3 and one patient had stage 4. Two patients (5.4%) presented with acute ischemia and received trombolysis before recanalization. Patency results were calculated using Kaplan and Meier analysis. The mean follow-up was 26 months.
Results:
Technical success was 97.4%. Thirty-day mortality was 2.7%. The primary patency rate was 94%, 89% and 77% at 1, 3 and 5 years respectively. Three re-occlusions (8.1%) and one restenosis (2.7%) were observed during follow-up. The secondary patency (SP) rate was 100%, 94% and 94% after 1, 2 and 3 years. Fifteen patients underwent an associated procedure. A kissing stent procedure in three patients, a contralateral PTA of an iliac stenosis in 8, a femoro-femoral bypass in 2, a femoropopliteal bypass in 1 and an femoral endarterectomy in 2. The procedure related complication rate was 5.4%.
Conclusion:
Long-term results of iliac recanalization are excellent without major complications if the procedure is technically successful. The endovascular procedure can be an alternative to an iliofemoral or aortobifemoral bypass in a high risk population.
