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Long-Term Outcomes and Major Adverse Limb Events in Claudicants Undergoing Iliac Artery Stenting versus Superficial

Richard Shi1, Saranya Sundaram1, Adam Tanious1

  • 1Division of Vascular Surgery, Medical University of South Carolina, Charleston SC.

Annals of Vascular Surgery
|May 11, 2025
PubMed

Insights

Superficial femoral artery (SFA) stenting for claudication leads to more complications and adverse limb events within one year compared to iliac artery stenting. However, long-term symptom relief is similar for both procedures.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Peripheral Artery Disease

Background:

  • Iliac artery and superficial femoral artery (SFA) stenting are common interventions for claudication.
  • Investigating major adverse limb events (MALE), symptoms, and complications is crucial for comparing these procedures.

Purpose of the Study:

  • To compare major adverse limb events (MALE), perioperative complications, and symptom resolution between iliac artery and SFA stenting in claudicant patients.
  • To identify risk factors associated with MALE after lower extremity revascularization.

Main Methods:

  • Retrospective analysis of the Vascular Quality Initiative (VQI) Peripheral Vascular Intervention registry (2010-2022).
  • Inclusion of patients undergoing first-time, isolated iliac artery or SFA stenting for claudication, excluding critical limb ischemia or prior interventions.
  • Primary endpoint: MALE (patency loss, amputation, reintervention). Kaplan-Meier and Cox regression analyses were used.

Main Results:

  • 2,250 iliac artery stents and 1,374 SFA stents were analyzed.
  • Iliac stenting showed decreased intraoperative fluoroscopy time, contrast usage, and dissection rates.
  • One-year MALE-free rates were 94% for iliac vs. 83% for SFA stenting (P < 0.001), with SFA stenting strongly associated with MALE (HR: 2.96).

Conclusions:

  • Superficial femoral artery (SFA) stenting is associated with higher rates of perioperative complications and 1-year MALE compared to iliac artery stenting.
  • Despite initial differences, long-term claudication symptom resolution did not differ significantly between the two procedures.
Abstract

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