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[Percutaneous transluminal angioplasty of iliac occlusions]
K C Vogt1, S R Just, N D Levi-Mazloum
1Karkirurgisk Afdeling, Rigshospitalet, København.
Insights
Percutaneous transluminal angioplasty (PTA) is effective for treating iliac artery occlusions, achieving high recanalization and patency rates. However, longer occlusions may have lower patency, and complex cases require careful consideration.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Percutaneous transluminal angioplasty (PTA) is established for iliac artery stenosis.
- PTA for iliac artery occlusions is controversial due to technical challenges and lower success rates compared to stenosis.
Observation:
- A study evaluated 31 cases of PTA for iliac artery occlusions over three years.
- Primary recanalization was achieved in 71% of cases, with stents used in 16 patients.
Findings:
- One- and six-month cumulative patency rates were 95% and 85%, respectively.
- A trend towards lower patency was observed in occlusions longer than 5 cm.
- The complication rate was 10%, primarily due to distal embolization, which was successfully managed with PTA and stenting.
Implications:
- PTA is a viable alternative to surgical treatment for iliac artery occlusions.
- Exclusion of long occlusions involving both common and external iliac arteries is recommended.
- These findings align with international studies, supporting PTA's role in managing iliac artery occlusions.
Abstract:
Percutaneous transluminal angioplasty (PTA) has become an established treatment modality for iliac artery stenosis. PTA of iliac artery occlusions, however, remains a topic of controversy due to difficulties with mechanical recanalization, a lower patency rate and a higher complication rate than obtained after PTA of iliac artery stenosis. During a three year period, we performed 31 PTA's of iliac artery occlusions. The primary recanalization rate was 71% (22 occlusions). Stents were applied in 16 patients. The cumulated patency rates were 95% and 85% after one and six months respectively. There was one late reocclusion after two years. We found a tendency towards inferior patency in the longer occlusions (> or = 5cm). The complication rate was 10% due to three episodes of distal embolisation, all of which were successfully treated immediately with additional PTA and stenting. These results are in accordance with the results of international studies, and suggest that PTA is a useful alternative to surgical treatment of iliac artery occlusions, albeit long occlusions involving both the common and the external iliac artery should be excluded.