Endovascular treatment of external iliac artery occlusive disease: midterm results
Sergio Revuelta Suero1, Isaac Martínez López, Manuel Hernando Rydings
1Servicio de Angiología y Cirugía Vascular, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain.
Insights
Endovascular treatment for external iliac artery (EIA) occlusive disease shows good midterm patency. Covered stents were linked to lower primary patency, while clinical factors did not impact outcomes.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- External iliac artery (EIA) occlusive disease often causes limb-threatening ischemia.
- Endovascular treatment offers a less invasive approach compared to open surgery.
Purpose of the Study:
- To evaluate midterm outcomes of endovascular treatment for EIA occlusive disease.
- To identify factors influencing treatment patency.
Main Methods:
- Retrospective analysis of 99 patients with EIA occlusive disease treated between 2005 and 2012.
- Lesions were predominantly TASC A/B, treated with angioplasty and/or stenting.
- Follow-up included clinical and hemodynamic assessments.
Main Results:
- Midterm follow-up (median 27.5 months) showed primary and secondary patency rates of 89.7% and 94.1% at 30 months.
- Covered stents were associated with significantly lower primary patency (p=0.006).
- No correlation found between patency and patient age, clinical status, or comorbidities.
Conclusions:
- Endovascular therapy for TASC A/B EIA lesions provides favorable short- and midterm outcomes with low morbidity and mortality.
- Lesions in the distal EIA treated with simple angioplasty or stenting had poorer outcomes.
- Clinical factors did not predict patency rates.
Purpose:
To report midterm outcomes for endovascular treatment of external iliac artery (EIA) occlusive disease and assess possible factors affecting patency.
Methods:
A retrospective analysis was conducted of 99 consecutive patients (91 men; mean age 67.3 years) with claudication (n=70) or critical limb ischemia (n=29) owing to occlusive EIA disease treated at our center from January 2005 to June 2012. The majority of lesions (79/108) were TASC A/B. Lesions were a mean 42.2 mm long (range 10-125); 43/108 affected the distal third of the EIA. Balloon angioplasty alone was performed in 7 limbs, while the remaining 101 lesions were stented (65 self-expanding, 24 balloon-expandable, and 12 covered). Clinical and hemodynamic follow-up was performed at 1, 3, 6, and 12 months after therapy and yearly thereafter. The factors examined were procedure characteristics and patency rates.
Results:
Over a median follow-up of 27.5 months (range 1-89), there were 2 (1.9%) early occlusions followed by a successful reintervention, 4 late occlusions, and 5 hemodynamic failures followed by 7 reinterventions. These events led to primary and secondary patency rates at 30 months of 89.7% and 94.1%, respectively. No differences in patency rates were detected according to age, clinical state, or comorbidity. Use of covered stents (p=0.006) was the only variable associated with lower primary patency rates.
Conclusion:
Endovascular therapy to treat TASC A/B lesions of the EIA yielded good short and midterm patency and low early morbidity and mortality. Lesions involving the distal third of the EIA treated by simple angioplasty ± stenting fared worse. No clinical factors could be correlated with patency.
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