Angiographic classification of occlusive stenotic lesion of the internal iliac artery

Abstract

The OBJECTIVE was to develop a classification of isolated occlusive stenotic lesion (OSL) of the internal iliac artery (IIA) based on the analysis of pelvic arteriography data.METHODS AND MATERIALS. The retrospective study included 90 patients (mean age 64.6±7.4 years) who underwent pelvic catheter arteriography and were diagnosed with unilateral or bilateral hemodynamically significant (stenosis >50% or occlusion) occlusive stenotic lesion (OSL) of the internal iliac artery (IIA). An analysis of the branching pattern of the IIA according to the Yamaki classification and an assessment of the degree and prevalence of lesion to its basin, including three arterial segments, were carried out.RESULTS. Among 158 (88%) IIA with hemodynamically significant patency disorder in 90 (57%) IIAs, the isolated OSL were identified, and its three types were identified: I (n=29) – local hemodynamically significant OSL in one arterial segment of the IIA basin; II (n=44) – diffuse hemodynamically significant OSL in several arterial segments with partial preservation of contrasted lumen of the trunk and/or branches of the IIA; III (n=17) – chronic occlusion with lack of contrasting of the trunk and branches of the IIA. Branching types «A» and «B» according to Yamaki classification were identified in 47 (52 %) and 7 (8 %) cases, respectively. It was not possible to reliably establish the branching variant of 36 (40 %) IIAs, in the vast majority of cases due to the prevalence of lesions in its basin (belonged to types II and III). A satisfactory level of agreement between two vascular surgeons on the application of the proposed classification was established.CONCLUSION. The proposed classification allows assessing the prevalence of occlusive stenotic lesion of the internal iliac artery, which may be important when choosing tactics and predicting the results of surgical treatment of such patients; further study of the possibility of its use in clinical practice is necessary.