Management of recurrent iliac artery stenosis in individuals aged 55 or less

Aortoiliac disease is the most common location for symptomatic peripheral arterial disease in young patients. Angioplasty with stenting has become the initial treatment of choice for most patients. However, the treatment of recurrence is poorly studied, particularly in those who are considered candidates for surgical bypass. We reviewed our experience in 64 patients (91 limbs), mean age 48 years, who were treated with angioplasty (3%), repeat stenting (91%), or bypass (5%) for recurrent symptoms. These patients had TASC II A/B lesions predominantly of the common iliac arteries (78%). Time to retreatment was 13.6 months after the initial procedure mainly for claudication (mean ankle-brachial index 0.64). Primary, primary-assisted, and secondary patency rates for angioplasty were 85 ± 9%, 93 ± 7%, 100% after angioplasty; 76 ± 6%, 94 ± 3%, 96 ± 3% after stenting; and 86 ± 9% after bypass surgery at 12 months. Amputation-free survival rates were not statistically different out to 4 years. In conclusion, endovascular reintervention and bypass surgery demonstrate similar outcomes in patients with recurrent symptoms after failed angioplasty with stenting.