Contemporary Outcomes After Endovascular Treatment for Aorto-Iliac Artery Disease

Soga, Yoshimitsu; Iida, Osamu; Kawasaki, Daizo; Yamauchi, Yasutaka; Suzuki, Kenji; Hirano, Keisuke; Koshida, Ryoji; Kamoi, Daisuke; Tazaki, Junichi; Higashitani, Michiaki; Shintani, Yoshiaki; Yamaoka, Terutoshi; Okazaki, Shinya; Suematsu, Nobuhiro; Tsuchiya, Taketsugu; Miyashita, Yusuke; Shinozaki, Norihiko; Takahashi, Hiroki

doi:10.1253/circj.cj-12-0492

Cited by 100 publications

(111 citation statements)

References 23 publications

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“…Baseline characteristics of the patients with technical success according to the need for TLR combined outflow lesions are independent predictors of loss of primary patency. [15][16][17][18] In the present study, we found that small EIA diameter was also an important determinant of TLR. Similarly, Soga et al reported that reference vessel diameter <8.0 mm measured by angiography during the procedure was an independent predictor of restenosis.…”

Section: Supplementary Filessupporting

confidence: 61%

Impact of Vessel Diameter Measured by Preprocedural Computed Tomography Angiography on Immediate and Late Outcomes of Endovascular Therapy for Iliac Artery Diseases

Hong

Shin

et al. 2017

Circ J

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incidence of procedural failure and periprocedural complications has been reported to be 1-5% and 4-20%, respectively, frequencies that are still clinically significant. 5- 12 We therefore investigated whether vessel diameters measured by preprocedural CTA affects the immediate (procedural failure or vessel-specific complications) and late outcomes (the need of target lesion revascularization [TLR]) of endovascular therapy for iliac artery disease. Methods SubjectsBetween 2005 and 2013, a total of 590 patients underwent endovascular therapy for symptomatic iliac artery disease. Of them, 92 with restenotic lesions, 16 with dissections, and 37 who were previously treated with stent grafts or bypass graft were excluded. Among the remaining 445 A recent meta-analysis has demonstrated that computed tomography angiography (CTA) has high diagnostic accuracy with respect to the presence and extent of peripheral artery disease (PAD). 1 CTA, with duplex ultrasound and magnetic resonance angiography, is currently recommended as a noninvasive imaging strategy for localizing lower extremity arterial disease lesions and for considering the revascularization options. 2-4 Also, preprocedural CTA can provide 3D data on the diameters of diseased segments, in addition to the degree of stenosis, whereas fluoroscopic angiography only provides 2D information on luminal narrowing. However, the prognostic value of vessel diameter measured by CTA for outcomes of endovascular therapy has not been evaluated. Although endovascular therapy has achieved high technical success rates with excellent patency for iliac artery disease and its indication has been expanded to complex lesions, 4 the Myeong-Ki Hong, MD, PhD; Yangsoo Jang, MD, PhDBackground: We evaluated whether vessel diameters measured by preprocedural computed tomography angiography (CTA) affects the immediate and late outcomes of endovascular therapy for iliac artery diseases.

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Section: Supplementary Filessupporting

confidence: 61%

Impact of Vessel Diameter Measured by Preprocedural Computed Tomography Angiography on Immediate and Late Outcomes of Endovascular Therapy for Iliac Artery Diseases

Hong

Shin

et al. 2017

Circ J

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“…The 3-year primary patency rate after EVT for the aorto-iliac artery lesion with stents has been reported 76-88 % [5][6][7]. Previous studies have reported several factors associated with patency after EVT for the iliac artery lesion [5,7,8]. Female gender, diabetes, renal failure, absence of aspirin, tiny vessel, and out-flow disease were identified as independent predictors of primary patency after stent implantation [7].…”

Section: Introductionmentioning

confidence: 96%

“…Especially, favorable results have been reported after EVT with stents for the aorto-iliac artery lesion, compared with the femoro-popliteal artery lesion. The 3-year primary patency rate after EVT for the aorto-iliac artery lesion with stents has been reported 76-88 % [5][6][7]. Previous studies have reported several factors associated with patency after EVT for the iliac artery lesion [5,7,8].…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have reported several factors associated with patency after EVT for the iliac artery lesion [5,7,8]. Female gender, diabetes, renal failure, absence of aspirin, tiny vessel, and out-flow disease were identified as independent predictors of primary patency after stent implantation [7]. Intravascular ultrasound (IVUS) is a device providing cross-sectional images of the vessel wall with high resolution and is widely used as an imaging device during coronary intervention [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Impact of intravascular ultrasound findings on long-term patency after self-expanding nitinol stent implantation in the iliac artery lesion

et al. 2015

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Although intravascular ultrasound (IVUS) predictors of stent patency for the coronary artery lesion have been established, little is known about IVUS predictors of stent patency for the aorto-iliac artery lesion. We analyzed 154 lesions of 122 patients who underwent stent implantation for iliac artery lesions. Quantitative and qualitative IVUS analyses were performed for pre- and post-procedural IVUS imaging in all lesions. Target lesion revascularization (TLR) was defined as clinically driven revascularization with >50 % angiographic stenosis of the target lesion. The mean follow-up period was 39 ± 16 months. TLRs were performed in 13 lesions (8.4 %). Post-procedural minimum stent area (MSA) was significantly smaller in the TLR group compared to the no-TLR group (16.0 ± 5.8 vs. 25.6 ± 8.5 mm(2), p < 0.001). Stent edge dissection was frequently observed in the TLR group compared to the no-TLR group (53.8 vs. 24.1 %, p = 0.04). Multivariate analysis revealed that post-procedural MSA (OR = 0.76, p < 0.01) and stent edge dissection (OR = 10.4, p < 0.01) were independent IVUS predictors of TLR. Receiver-operating characteristic analysis identified post-procedural MSA <17.8 mm(2) as the optimal cut-point for the prediction of TLR (AUC = 0.846). Post-procedural MSA and stent edge dissection could predict long-term stent patency in the iliac artery lesion. Our results propose that adequate stent enlargement without edge dissection might be important to reduce TLR in the iliac artery lesion.

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“…For the aortoiliac and femoropopliteal arterial areas, the therapeutic results of lower limb EVT including long-term outcomes have improved and become equivalent to those of bypass surgery, [1][2][3][4] and application of EVT for the first treatment has been shown to be appropriate, although there are some exceptions. Regarding EVT for PAD with lesions mainly below the knee, the long-term patency rate is still low, and which of EVT or bypass surgery should be performed for the first treatment is the most controversial issue.…”

Section: Introductionmentioning

confidence: 99%

Strategy of Revascularization for Critical Limb Ischemia Due to Infragenicular Lesions—Which Should Be Selected Firstly, Bypass Surgery or Endovascular Therapy?

Ohmine

Iwasa

Yamaoka

2015

Annals of Vascular Diseases

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Background and Objectives:In patients with peripheral arterial diseases (PADs) due to infra-popliteal (below the knee; BTK) lesions, we often encounter situations requiring the immediate selection of either of two revascularization methods, namely bypass surgery or endovascular therapy (EVT). However, the question of whether endovascular or surgical revascularization should be performed initially for critical limb ischemia (CLI) patients with BTK lesions has not been clarified. To assess the efficacy and durability of EVT or bypass as a first approach, we evaluated the short-and mid-term outcomes of the first revascularizations achieved using EVT (EVT First Group; EVT-first) compared with bypass (Bypass First Group; Bypass-first). To verify the validity of each initial revascularization, we explored factors influencing overall survival (OS) rates using multivariate analyses. Methods: A total of 169 consecutive BTK revascularization procedures (150 patients) for CLI conducted at our facility between November 2006 and July 2012 were analyzed. Patients undergoing revascularization were divided into two groups (EVT-first or Bypass-first), with 102 patients undergoing endovascular therapy first (EVT-first) and 51 undergoing bypass surgery first (Bypass-first). No statistically significant differences were noted between the two groups with respect to preoperative background including age, gender, and cardiovascular risk factors (hypertension, diabetes, hyperlipidemia, coronary arterial disease (CAD), chronic heart failure (CHF), cerebrovascular disease, and hemodialysis). Technical success was defined as a single straight-line flow to the ankle after completion angiography of the first revascularization method. Hemodynamic success was defined as a postoperative skin perfusion pressure of the foot exceeding 40 mmHg. Results:The average age of patients was 76.0 years (range, 46-98 years; 65 men and 37 women) and 72.3 years (range, 43-93 years; 35 men and 13 women) in the EVT-first and Bypass-first groups, respectively. Patient follow-up ranged from 1 to 50 months (mean, 15 months). Respective technical and hemodynamic success rates were 96.2% and 66.7% for EVTfirst and 100% and 94% for Bypass-first, respectively. Treatment was required an average of 1.5 times for EVT-first and 1.2 times for Bypass-first. Respective rates for other factors examined in the EVT-first and the Bypass-first groups were: major amputation rates 30 days post-procedure, 5.9%, and 3.9%; mortality rates 30 days post-procedure, 3.9%, and 0%; oneyear AFS rates, 71.7%, and 79.5%; OS rates, 73.5% and 83.9%; and limb salvage rates, 88.8%, and 91.0%. Multivariate-analysis of all subjects in the two groups revealed that the OS rates were affected by four risk factors as follows: (1) age greater than 80 years, (2) CAD, (3) CHF, and (4) a non-ambulatory limb. Conclusion: For patients with CLI due to BTK lesions and whose saphenous veins are in poor condition or are in poor general condition having two or more of the four severe risk factors, the EVT-First p...

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Contemporary Outcomes After Endovascular Treatment for Aorto-Iliac Artery Disease

Cited by 100 publications

References 23 publications

Impact of Vessel Diameter Measured by Preprocedural Computed Tomography Angiography on Immediate and Late Outcomes of Endovascular Therapy for Iliac Artery Diseases

Impact of Vessel Diameter Measured by Preprocedural Computed Tomography Angiography on Immediate and Late Outcomes of Endovascular Therapy for Iliac Artery Diseases

Impact of intravascular ultrasound findings on long-term patency after self-expanding nitinol stent implantation in the iliac artery lesion

Strategy of Revascularization for Critical Limb Ischemia Due to Infragenicular Lesions—Which Should Be Selected Firstly, Bypass Surgery or Endovascular Therapy?

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