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Initial experience with the Palmaz stent for aortoiliac stenoses
Y G Wolf1, R A Schatz, H J Knowles
1Division of Vascular Surgery, Scripps Clinic and Research Foundation, La Jolla, California 92037.
Insights
The Palmaz stent effectively treated aortoiliac artery stenoses and occlusions, significantly reducing pressure gradients and resolving symptoms in most patients. Long-term follow-up showed a manageable recurrence rate, supporting its use in vascular interventions.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Biomedical Engineering
Background:
- Aortoiliac artery disease presents significant challenges in vascular reconstruction.
- Endovascular techniques, including stenting, offer an alternative to traditional surgical repair.
Purpose of the Study:
- To evaluate the efficacy and safety of the Palmaz stent in treating aortoiliac artery stenoses and occlusions.
- To assess the outcomes of Palmaz stent placement in conjunction with surgical procedures for complex lower extremity arterial disease.
Main Methods:
- Retrospective review of 37 consecutive patients treated with Palmaz stents in the aortoiliac arteries.
- Analysis of procedural success, clinical outcomes, and imaging findings at follow-up.
- Inclusion of patients undergoing combined endarterectomy and stenting for common femoral and iliac obstructions.
Main Results:
- Significant reduction in stenosis from 57% to 1% (p < 0.01) and pressure gradients from 45 mmHg to 1.3 mmHg (p < 0.01).
- Symptom resolution or improvement in 35 out of 37 patients.
- A 16% recurrence of symptoms at a mean 12-month follow-up, with 11% symptomatic restenosis on routine arteriography.
Conclusions:
- The Palmaz stent demonstrates efficacy in managing aortoiliac stenoses and occlusions.
- Intraoperative use of Palmaz stents in conjunction with surgical correction of outflow is effective.
- Close multidisciplinary follow-up is recommended for patients treated with Palmaz stents.
Abstract:
The initial 37 consecutive patients to be treated at our institution with the Palmaz stent placed in the aortoiliac arteries were retrospectively reviewed. In these patients, 50 stenoses and six occlusions were treated with 128 stents. Nine patients with combined iliac and common femoral obstruction underwent common femoral endarterectomy and profoundaplasty with intraoperative iliac artery angioplasty and stent application. Stenoses were reduced from 57 +/- 17% to 1 +/- 5% (p < 0.01), and peak systolic pressure gradients across the lesions were reduced from 45 +/- 30 mm Hg to 1.3 +/- 3.4 mm Hg (p < 0.01). Symptoms resolved in 27 patients and improved in eight patients. One patient died and four patients were treated nonoperatively for complications. During a mean follow-up of 12 months (6 to 21 months), six patients had recurrence of symptoms (16%) and four patients died of other diseases. Routine arteriograms after 6 months in 19 patients demonstrated recurrent mild to moderate stenoses (9% to 43%) in six patients (32%), but only two were symptomatic (11%). Secondary procedures included reexpansion of aortic and iliac stents in two patients and aortofemoral bypass in two patients. Early results suggest the efficacy of the Palmaz stent in the management of aortoiliac stenoses and its use intraoperatively in conjunction with surgical correction of outflow. Close follow-up of these patients by multidisciplinary groups is warranted.