Aortoiliac Insufficiency: Long-term Experience with Stent Placement for Treatment

Murphy, Timothy P.; Ariaratnam, Nikki S.; Carney, Wilfred I.; Marcaccio, Edward J.; Slaiby, Jeffrey M.; Soares, Gregory M.; Kim, H. Myra

doi:10.1148/radiol.2311030408

Cited by 87 publications

(39 citation statements)

References 38 publications

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“…Aortoiliac and aortofemoral bypass procedures are associated with 74% to 95% 5-year patency rates, respectively, which are comparable but not superior to percutaneous therapies. 26,27 Because many of these operations involve extensive abdominal incision, morbidity (eg, infection and bleeding) and mortality can become significant in the at-risk patient.…”

Section: Patient Selection and Outcomes Aortoiliac Diseasementioning

confidence: 99%

“…27,37-39 The 30-day mortality risk was 0.5%, much lower than the 4% weighted mortality risk for aortofemoral bypass. 27 Variables that correlate with poor outcomes after iliac stent placement include occlusions rather than stenoses, longer lesions, female gender, and external iliac stent placement. Occlusions of the iliac arteries may be approached with a success rate of 90%, a serious complication rate of 1.4%, and a 3-year primary patency rate of 78%, with a secondary patency rate of 86%.…”

Section: Patient Selection and Outcomes Aortoiliac Diseasementioning

confidence: 99%

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Endovascular Therapies for Peripheral Arterial Disease

2007

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Abstract-Peripheral arterial disease is one manifestation of systemic atherosclerosis. The prevalence of peripheral arterial disease increases with the age of the population. It is important to remember the significant association of coincident coronary artery disease, which is the major cause of mortality in these patients. (Figure 1). 1,2 It is important to remember the significant association of coincident coronary artery disease and cerebrovascular disease in these patients, because it represents the major cause of major morbidity and mortality in the PAD population. 3 Remarkable technological advances in the past decade, along with patient preference, have shifted revascularization strategies from traditional open surgical approaches toward lower-morbidity percutaneous endovascular treatments. Catheter-based revascularization of the lower extremities was first performed by Charles Dotter 4 and advanced by Andreas Gruentzig, who employed then newly developed inflatable balloon catheters that could dilate vascular stenoses. 5 The availability of stents, more than any other advance, has fueled the growth of catheterbased procedures by improving the safety, durability, and predictability of percutaneous revascularization.Endovascular therapy offers several distinct advantages over open surgical revascularization for selected lesions. 6,7 It is performed with local anesthesia, which enables the treatment of patients who are at high risk for general anesthesia. The morbidity and mortality from catheter-based therapy is extremely low, especially compared with open surgical revascularization. After successful percutaneous revascularization, patients are ambulatory on the day of treatment, and unlike after vascular surgery, they can often return to normal activity within 24 to 48 hours of an uncomplicated procedure. Endovascular therapies generally do not preclude or alter subsequent surgery and may be repeated if necessary.Multiple specialties, including interventional cardiology, have contributed to the advancement of the field of peripheral vascular intervention over the past several decades. 8 The recognition of an unmet need for a trained cadre of clinicians to care for patients with PAD prompted the development of a core curriculum document (COCATS-11) 9 and a multispecialty societal competency statement. 10 The American Heart Association and American College of Cardiology have published guidelines and recommendations for the diagnosis and treatment of PAD. 2 Improved patient and physician awareness of PAD and the availability of high-quality noninvasive diagnostic imaging have increased the number of patients seeking treatment for PAD. Diagnostic Evaluation Noninvasive AssessmentThe initial assessment should include a physical examination, with the patient's shoes and socks removed, to look for signs of acute or chronic peripheral ischemia and distal embolization and to determine the status of the peripheral pulses. The abdomen is examined for evidence of an aortic aneurysm, and blood pressure should be meas...

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Section: Patient Selection and Outcomes Aortoiliac Diseasementioning

confidence: 99%

Section: Patient Selection and Outcomes Aortoiliac Diseasementioning

confidence: 99%

Endovascular Therapies for Peripheral Arterial Disease

2007

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“…Murphy revealed in his study a bypass potency of 74% at 8 years after stent placement suggesting the durability of these procedures. 27 In addition, there were almost 3% of patients who died in the whole sample with no statistical difference between groups.…”

Section: Discussionmentioning

confidence: 92%

Demographic and Comorbidity Pattern of Patients with Critical Limb Ischemia

et al. 2017

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Aim: The present study aimed at identifying the pattern of patients with critical limb ischemia (CLI) compared with those with peripheral arterial occlusive disease (PAOD). Materials and methods: A four-year retrospective study was conducted with patients hospitalized in the Second Surgical Clinic at the Emergency County Hospital Cluj-Napoca. The medical charts of patients with PAOD (n=466) and CLI (n=223) were reviewed and data were collected. Results: The study included 689 patients; mean age 67 years for PAOD patients and 65 years for CLI patients. A significantly higher percentage of patients were male in both groups (79.25%, P < 0.0001). Most of the patients in both groups had received at least a secondary education (P < 0.0001). Most of the subjects in both groups were smokers (>71.30%) with no difference between groups (P = 0.566). No significant differences were found between the groups in comorbidities (diabetes, arterial blood hypertension, cardiac ischemia, rhythm disorders, P > 0.05). There were more CLI patients that were overweight than overweight patients with PAOD (P = 0.0004). High serum cholesterol (>200 mg/dL) and triglycerides (>150 mg/dL) levels were found in the CLI group (P < 0.05). Age was identified as a risk factors for amputation (OR = 1.03, 95%Cl [1.01−1.05], P = 0.0012). Conclusions: The profile of a patient with critical limb ischemia and peripheral arterial occlusive disease is a 65-67-year-old male smoker with at least a secondary education. The CLI patient is overweight with pathological serum levels of cholesterol and triglycerides.

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“…Data about cardiovascular morbidity and mortality in these patients have been published before (6). Some studies about endovascular treatment of the iliac arteries with a follow-up of 4 years or longer have been published (11)(12)(13)(14)(15)(16). Researchers in most of these studies reported results for iliac patency, and these results seem to be in accordance with our outcomes: 72%-92% secondary iliac artery patency after a follow-up of 4.0 -7.5 years.…”

Section: Discussionmentioning

confidence: 99%

Dutch Iliac Stent Trial: Long-term Results in Patients Randomized for Primary or Selective Stent Placement

Seeger¹

2008

Yearbook of Surgery

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Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Klein, W. M., van der Graaf, Y., Seegers, J., Spithoven, J. H., Buskens, E., van Baal, J. G., ... Mali, W. P. T. M. (2006). Dutch iliac stent trial: Long-term results in patients randomized for primary or selective stent placement. RADIOLOGY, 238(2), 734-744. CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Purpose:To determine long-term results of the prospective Dutch Iliac Stent Trial. Materials and Methods:The study protocol was approved by local institutional review boards. All patients gave written informed consent. Two hundred seventy-nine patients (201 men, 78 women; mean age, 58 years) with iliac artery disease were randomly assigned to undergo primary stent placement (143 patients) or percutaneous transluminal angioplasty (PTA) with selective stent placement in cases in which the residual mean pressure gradient was greater than 10 mm Hg across the treated site (136 patients). Before and at 3, 12, and 24 months and 5-8 years after treatment, all patients underwent assessment, which included duplex ultrasonography (US), ankle-brachial index (ABI) measurement, Fontaine classification of symptoms, and completion of the Rand 36-Item Health survey for quality-of-life assessment. Treatment was considered successful for symptoms if symptoms increased at least one Fontaine grade, for ABI if ABI increased more than 0.10, for patency if peak systolic velocity ratio at duplex US was less than 2.5, and for quality of life if the RAND 36-Item Health Survey score increased more than 15 points. Effects of both treatments on symptoms, quality of life, patency, and ABI were compared by using survival analyses. Results:Patients who underwent PTA and selective stent placement had better improvement of symptoms (hazard ratio [HR], 0.8; 95% confidence limits [CLs]: 0.6, 1.0) than did patients treated with primary stent placement, whereas ABI (HR, 0.9; 95% CLs: 0.7, 1.3), iliac patency (HR, 1.3; 95% CLs: 0.8, 2.1), and score for quality of life for nine survey dimensions did not support a difference between treatment groups. Conclusion:Patients treated with PTA and selective stent placement in the iliac artery had a better outcome for symptomatic success compared with patients treated with primary stent placement, whereas data about iliac patency, ABI, and quality of life did not support a difference between groups.RSNA, 2005

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Aortoiliac Insufficiency: Long-term Experience with Stent Placement for Treatment

Abstract: Findings from long-term experience with aortoiliac stent placement for treatment of chronic lower-extremity ischemia confirmed the procedure to be a durable, low-risk revascularization option.

Cited by 87 publications

References 38 publications

Endovascular Therapies for Peripheral Arterial Disease

Endovascular Therapies for Peripheral Arterial Disease

Demographic and Comorbidity Pattern of Patients with Critical Limb Ischemia

Dutch Iliac Stent Trial: Long-term Results in Patients Randomized for Primary or Selective Stent Placement

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