Intraoperative iliac artery stents: combination with infra-inguinal revascularization procedures

Iliac artery percutaneous transluminal angioplasty (PTA) can effectively provide in-flow for subsequent distal vascular reconstruction. Iliac artery stents may improve the initial hemodynamics and long term patency of PTA, and thus may be well-suited for combined proximal PTA with distal bypass procedures. This report reviews our preliminary experience with iliac artery stenting in combination with infra-inguinal vascular reconstruction. Thirteen iliac artery stent procedures combined with simultaneous distal revascularization were performed in 11 patients. Ten procedures were performed for limb salvage, two for disabling claudication, and one before planned orthopedic surgery. Distal revascularization procedures included seven femoropopliteal, four femorotibial bypasses, one common femoral endarterectomy, and one thrombectomy of a femoropopliteal bypass. Stent placement was technically successful in all patients. Mean pre-operative ankle-brachial index (ABI) was 0.41 (+/- 0.28), which improved to 0.91 (+/- 0.18) post-operatively (P < 0.0001). Mean systolic iliac artery gradients across the lesions improved from 27.1 (+/- 9.8) mm Hg to 2.7 (+/- 3.4) mm Hg after stent placement (P < 0.0001). Mean follow-up is 5.8 months (range 1-12 months). Two femoropopliteal bypass grafts occluded in the follow-up period. One occlusion was caused by a mid-vein graft stenosis that was repaired with subsequent graft patency. The other graft occlusion occurred in a patient with rest pain who did not require a second bypass procedure, as the ABI increased from 0.3 to 0.7 following stent placement with resolution of symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)