Abstract
Background: To evaluate initial technical results and long-term patency after treatment of iliac artery occlusions with percutaneous angioplasty and stent deployment. Methods: Between July 1997 and April 2006, 218 iliac endovascular procedures were performed on 171 patients. The chronic total occlusions of iliac artery were seen in 61 lesions on 60 patients, mean age 70 years. Fifty one patients were men, 9 were women. The occlusion was approached from the ipsilateral and/or contralateral common femoral artery with an angled-tip hydrophilic guide wire (0.035 inch). Angioplasty performed using an appropriately sized balloon and recanalized vessel were treated with a Palmaz stent, Easy Wallstent, Luminex stent and Smart stent. The follow up period ranged from 2 months to 67 months (mean 25 months). All patients underwent assessment of patency by duplex ultrasound and clinical assessment, including measurement of ankle/brachial index (ABI). Results: Initial technical success was achieved in 49 of 61 lesions (80%). The lengths of occlusion varied from 1.0 cm to 18 cm (mean 8.6 cm), lesion were located in common iliac arteries (19). External iliac arteries (16) and in combinations of both (26). Distribution and lesion length stratified by TASC classification were TASC-B (19), TASC-C (15), TASC-D (27). The mean number of stents deployed in iliac lesions was 2.5±1.5. The cumulative 1, 3 and 5 year primary patency rates were 89%, 74% and 59%. The secondary 1, 3 and 5 year secondary patency rate were 100%, 92% and 92%. Two complications were observed: one subacute occlusion of the stented segments a day after the procedure and one case of cerebral embolic episode during a procedure that recovered without any damage. One distal embolization was seen in our series. In 7 cases reintervention was performed with angioplasty in the stent or deployment of a new stent. Iliac restenosis with unsuccessful secondary angioplasty mandated vascular surgery in 2 of 48 cases, femorofemoral cross-over bypass in one case and aortobifemoral bypass in one case. Conclusion: Endovascular treatment of iliac occlusion can be performed with reliable long-term patency and could have a place as an alternative therapeutic option to major transabdominal bypass surgery.
