[Percutaneous stenting in the treatment of iliac steno+-obstructive lesions]

The authors report their experience with Palmaz stents in the percutaneous treatment of steno-obstructive iliac artery lesions. A hundred and thirty-six patients suffering from claudicatio, pain at rest or distal lesions underwent 156 percutaneous stenting maneuvers. The indications to stenting were: acute obstruction or severe dissection after angioplasty (19 cases), residual stenosis > 30% (80 cases), large ulceration (7 cases), restenosis after previous percutaneous treatment (10 cases) and finally chronic obstruction (40 cases). In 154 cases the maneuver was successful, in 2 the stent was mispositioned because of technical problems and another stent had to be inserted. In 146 cases stenting was performed after transluminal angioplasty, while 10 chronic obstructions underwent stenting with no previous angioplasty to limit distal embolization. In all cases stenting improved the angiographic pattern more than angioplasty alone. Prophylactic drugs after stenting included only anti-aggregating substances. Marked clinical improvement was observed after stenting, and almost all patients gained at least one clinical stage. During stenting, 15 complications occurred (9.6%)--i.e, 2 external iliac artery dissections, 4 mild inguinal hematomas, 1 pseudoaneurysm, 1 segmental obstruction of the superficial femoral artery and 7 distal embolisms during recanalization of chronic occlusions. The complications were caused by the procedure, and especially by the large caliber of the introducer sheat; no complication was related to the stent itself. None of these complications needed major surgery. Over 3-34 months' follow-up (mean: 9 months), 1 obstruction and 2 restenoses occurred in 134 vessels; these lesions were treated successfully with thrombolysis and/or transluminal angioplasty (primary patency: 97.8%, secondary patency: 100%). In the authors' experience, percutaneous stenting represents a simple and fast procedure with very good technical and clinical results which can increase the capabilities of percutaneous revascularization procedures.