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Percutaneous endoluminal treatment of iliac occlusions: long-term follow-up in 105 patients
1Polyclinique Essey-les-Nancy, UCCI, France.
Insights
Percutaneous recanalization effectively treats iliac artery occlusions, offering a viable alternative to surgery. Stenting improves long-term outcomes, making it a recommended approach for chronic cases.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Iliac artery occlusions significantly impact patient mobility and quality of life.
- Traditional surgical bypass can be associated with considerable morbidity.
- Minimally invasive endovascular techniques offer potential advantages.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of percutaneous recanalization for iliac artery occlusions.
- To compare outcomes of different recanalization techniques, including stenting.
- To establish percutaneous recanalization as a first-line treatment option.
Main Methods:
- A cohort of 105 patients with iliac occlusions underwent percutaneous recanalization.
- Techniques included thrombolysis, excimer laser, mechanical thrombectomy, balloon angioplasty, and angioplasty with stenting.
- Lesion characteristics and procedural outcomes were analyzed, with long-term patency assessed over 6 years.
Main Results:
- An 88% primary recanalization rate was achieved, influenced by thrombus age but not lesion location.
- Six-year primary patency was 52% overall and 61% for recanalized lesions, with significantly better results for lesions < 6 cm.
- Secondary patency rates were 66% overall and 77% for recanalized lesions; stenting showed a trend towards improved results.
Conclusions:
- Percutaneous recanalization is a safe and effective alternative to vascular surgery for iliac occlusions.
- It represents a valuable first-line treatment strategy.
- Routine use of stents is recommended to enhance long-term outcomes in chronic iliac occlusions.
Purpose:
To evaluate the long-term results of percutaneous recanalization techniques in occluded iliac arteries.
Methods:
Percutaneous recanalization was attempted in 105 patients (97 men; mean age 56 years, range 34 to 80) with iliac occlusions using thrombolysis (n = 15), excimer laser (n = 4), mechanical thrombectomy (n = 16), balloon angioplasty alone (n = 23), and angioplasty plus stenting (n = 69). The majority of lesions (n = 72) were in the common iliac artery (CIA); 33 were in the external iliac artery (EIA).
Results:
The primary recanalization rate was 88% (92/105) independent of location (EIA: 90%, CIA: 86%) and lesion length, but dependent on age of thrombus (< 3 months: 100%, > 3 months: 79%, p < 0.02). Complications included 5 (4.8%) cases of distal embolism treated by thromboaspiration or Fogarty balloon embolectomy. Seven (6.7%) early thromboses were treated surgically. Primary and secondary patency rates were calculated at 6 years for all 105 cases and for the 92 recanalized lesions using life-table analysis. Overall, primary patency was 52% (CIA: 58%, EIA: 34%) and secondary 66% (CIA: 74%, EIA: 40%). Lesions < 6 cm had a primary patency of 70%, while those > 6 cm had a 31% rate (p < 0.01). Secondary patencies were 86% and 42%, respectively (p < 0.01). Among recanalized lesions, the primary patency was 61% (CIA: 69%, EIA: 38%) and secondary 77% (CIA: 88%, EIA: 45%; p < 0.05). Lesions < 6 cm had a primary patency rate of 72%, while longer lesions had a primary rate of 44% (p < 0.04); secondary patencies were 89% and 59%, respectively (NS). Primary patency without stent was 57% and with stent 65% (NS); secondary patency without stent was 71% and with stent 82% (NS).
Conclusions:
Percutaneous recanalization of iliac occlusions represents a true alternative to vascular surgery and a first-line treatment option. Stents have a tendency to improve long-term results and are recommended for routine use in chronic iliac occlusions.