Unilateral iliac artery stenting improves perfusion and symptoms in both limbs in patients with bilateral iliac
Chris Klonaris1, Athanasios Katsargyris, Anastasios Papapetrou
1First Department of Surgery, Vascular Division, LAIKON Hospital, Athens University Medical School, Greece.
Insights
Unilateral iliac artery stenting effectively treats stenosis and improves blood flow in the contralateral limb with chronic occlusion. This single intervention offers significant clinical benefit to both affected legs.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease
Background:
- Iliac artery stenosis and occlusion often present complex challenges in managing peripheral artery disease.
- Contralateral chronic iliac artery occlusion complicates treatment strategies for patients with unilateral iliac stenosis.
Purpose of the Study:
- To evaluate the efficacy of unilateral angioplasty and stenting of iliac artery stenosis in patients with contralateral chronic iliac artery occlusion.
- To determine if treating the stenosis alone can provide clinical and hemodynamic benefits to the untreated occluded limb.
Main Methods:
- Sixteen patients with unilateral iliac artery stenosis and contralateral chronic iliac artery occlusion underwent unilateral angioplasty/stenting.
- The study assessed technical success, immediate hemodynamic improvement (ankle-brachial index), and clinical outcomes for both limbs.
- Follow-up averaged 24 months to assess long-term patency and clinical success.
Main Results:
- Technical and immediate hemodynamic success rates were 100% for all treated limbs and the contralateral occluded limbs.
- Ankle-brachial index significantly improved in both the treated (0.67 to 0.88) and occluded (0.53 to 0.69) limbs (p<0.001).
- Clinical success was achieved in 100% of treated limbs and 93.8% of contralateral limbs, with sustained patency during follow-up.
Conclusions:
- Unilateral dilation/stenting of iliac artery stenosis is a viable treatment for selected patients with contralateral chronic iliac artery occlusion.
- This approach effectively increases blood flow and alleviates clinical symptoms in both the treated and untreated limbs.
- The procedure demonstrates high technical success, excellent hemodynamic improvement, and sustained clinical benefit in the long term.
Purpose:
To test the hypothesis that unilateral dilation of a common (CIA) or internal iliac artery (IIA) stenosis in selected patients with contralateral chronic iliac artery occlusion is adequate to offer clinical benefit to the untreated chronically occluded limb.
Methods:
Sixteen patients (11 men; mean age 66.7±4.9 years) with chronic occlusion of one CIA [with or without extension to the external iliac artery (EIA)] and CIA stenosis (n=11), IIA stenosis (n=3), CIA and IIA stenoses (n=1), or IIA and EIA stenoses (n=1) on the contralateral side were treated with unilateral angioplasty/stenting of the iliac artery stenosis as sole treatment for both limbs. Clinical and hemodynamic success of this approach was assessed for both limbs.
Results:
Eleven patients were treated with stenting of the stenosed CIA, 2 with IIA dilation, one with IIA stenting, one with stenting of both the CIA and IIA, and the last with IIA and EIA stenting. Technical success was obtained in all. Immediate hemodynamic success was also 100% for both limbs: the mean resting ankle-brachial index increased from 0.67±0.06 to 0.88 ± 0.04 on the stenosis side and from to 0.53±0.06 to 0.69±0.07 in the contralateral occluded limb (p<0.001). Clinical success was 100% for the treated limb immediately after the procedure and 93.8% for the contralateral limb. One patient with ischemic rest pain in the occluded limb continued to experience severe symptoms after contralateral CIA stenting despite hemodynamic improvement; he had a femorofemoral graft implanted 2 months after the initial intervention and was considered the only clinical failure. During a mean 24-month follow-up (range 12-54), all stented arteries remained patent.
Conclusion:
In selected patients with CIA or IIA stenosis and long chronic occlusion of the contralateral iliac axis, unilateral dilation/stenting of the stenosis alone increases blood flow and improves clinical symptoms to both limbs.
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