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Percutaneous revascularization of complex iliac artery stenoses and occlusions with use of Wallstents: three-year
T P Murphy1, M S Webb, R E Lambiase
1Division of Vascular and Interventional Radiology, Rhode Island Hospital, Brown University School of Medicine, Providence 02903.
Insights
Percutaneous Wallstent placement in iliac arteries shows high technical success for diffuse stenoses and chronic occlusions. This endovascular treatment offers favorable outcomes, improving symptoms and limb salvage rates in patients with peripheral artery disease.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Iliac artery disease, including diffuse stenoses and chronic occlusions, significantly impacts patient mobility and limb viability.
- Traditional open surgical repair carries risks, prompting the need for less invasive endovascular alternatives.
- Percutaneous revascularization aims to restore blood flow and improve clinical outcomes in patients with iliac artery insufficiency.
Purpose of the Study:
- To evaluate the effectiveness and safety of percutaneous Wallstent placement for treating complex iliac artery lesions.
- To assess outcomes in patients with hemodynamically significant diffuse stenoses, chronic occlusions, failed angioplasty, and flow-limiting dissections.
- To determine the impact of Wallstent treatment on symptoms, patency rates, and limb salvage.
Main Methods:
- A retrospective analysis of 94 iliac limbs in 66 patients treated with Wallstents.
- Indications included claudication (49 limbs) and limb-threatening ischemia (45 limbs).
- Lesion types comprised diffuse disease (42), chronic occlusion (39), failed angioplasty (9), and dissection (4).
Main Results:
- Technical success rate was 91% (86/94 limbs), with a 9% major complication rate.
- Ankle-brachial index improved significantly (0.51 to 0.76, P < .001), with 85% Rutherford criteria improvement.
- Primary patency was 78% at 1 year, decreasing to 53% by year 3; secondary patency remained high (86% at 1 year). Limb salvage rate was 98% for critical ischemia.
Conclusions:
- Percutaneous iliac artery revascularization using Wallstents is technically successful with acceptable complication rates.
- The procedure effectively improves symptoms and achieves excellent secondary patency for long-segment iliac disease and chronic occlusions.
- Wallstent treatment offers a viable endovascular option for patients with challenging iliac artery insufficiency.
Purpose:
To assess the outcome of percutaneous placement of Wallstents for treatment of hemodynamically significant diffuse stenoses (> 3 cm in length), chronic occlusions, failed angioplasty procedures, and flow-limiting dissection in the iliac arteries.
Materials And Methods:
Lesions in 94 iliac limbs were treated in 66 patients. Indications for stent placement included claudication in 49 limbs and limb-threatening ischemia in 45. Forty-two limbs were treated for diffuse disease, 39 for chronic occlusion, nine for failed angioplasty, and four for flow-limiting dissection.
Results:
Technical success was achieved in 86 of 94 limbs (91%), with major complications in 9% of patients. One death occurred within 30 days (not procedure-related). Ankle-brachial indexes improved from 0.51 +/- 0.24 to 0.76 +/- 0.22 (P < .001). Eighty-five percent demonstrated improvement under Rutherford criteria. Follow-up was obtained up to 38 months (mean, 14 months +/- 8). Cumulative primary patency rates were 78% at 1 year and 53% at 2 and 3 years (standard error 10%). Secondary patency rates were 86% at 1 year and 82% up to 32 months (standard error > 10% after 32 months). No significant decrease in mean ankle-brachial index was observed during follow up. No difference in primary patency was observed based on lesion type, symptom severity, lesion location, or runoff status. The limb salvage rate for patients with limb-threatening ischemia was 98% at a mean follow-up of 14 months +/- 7.
Conclusions:
Technical success and complication rates for percutaneous iliac artery revascularization with use of Wallstents are favorable, symptoms improved in the majority of patients, and excellent secondary patency can be achieved. With use of Wallstents, most patients with iliac artery insufficiency as a result of long-segment disease or chronic occlusions can be treated percutaneously.