Midterm Results of Endovascular Treatment for Complete Iliac Axis Occlusions Using Covered Stents

Al-Sibbai, Ahmad Amer Zanabili; Santervas, Lino Antonio Camblor; Marcos, Francisco Álvarez; Domínguez, Margarita Rivas; Castro-Madrazo, J.A. del; Coto, José Manuel Llaneza; Pérez, Manuel Alonso

doi:10.1016/j.avsg.2019.07.024

Cited by 8 publications

(3 citation statements)

References 31 publications

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“…In this context, there is no consensus regarding the preferred type of stent to be used for EIA [ 12 ]. The use of covered stents, bare-metal stents, balloon-expandable, and self-expandable stents is reported in the literature [ 2 , 3 , 6 , 9 , 19 – 21 ], but a direct comparison is not available specifically for this district.…”

Section: Discussionmentioning

confidence: 99%

“…The high flexibility allows to adapt to the EIA tortuous anatomy and to conform to the bending, elongation, and torsion that occur with hip movements. The covered design minimizes the chance of in-stent restenosis and allows for an aggressive post-dilatation avoiding the risk of rupture [ 4 – 6 ]. In this study, we achieved a satisfactory 90% primary patency and 91% secondary patency after 42 months from treatment.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of Self-Expanding Covered Stents for the Treatment of External ILIAC Artery Obstructive Disease

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Rey

Al-Sibbai

et al. 2023

Cardiovasc Intervent Radiol

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Purpose To describe the early results and mid-term patency rates of external iliac artery (EIA) stenting using self-expanding covered stents. Methods We conducted a multicenter retrospective study (2015–2021), including patients receiving primary endovascular treatment of external iliac artery occlusive disease with self-expanding covered stents. All patients were treated with the Viabahn (W.L Gore & Associates, Inc., Flagstaff, AZ–USA) stent. Patency and limb salvage rates were estimated with Kaplan–Meier curves. Results Ninety-three patients (mean age, 69 ± 9 years; 81% males) were treated for disabling claudication in 44%, rest pain in 28%, and tissue loss in 28%. TASC C/D lesions were present in 72% and iliac complete occlusion in 30%. Mean lesion length was 6.9 ± 2.4 cm; 30% had moderate/severe EIA calcifications; and the mean iliac tortuosity index was 1.17 ± 0.13. Technical success was 100%. There was one perioperative death (1.4%) and procedural complication rate was 6.5%. At 42 months (mean, 25 months), primary patency was 89.8% (95%CI 83–98); the presence of EIA tortuosity (tortuosity index > 1.25, 87.7 ± 11% vs 89.9 ± 8%; P = .6) or severe calcifications (87.6 ± 9% vs 96.0 ± 8%; P = .400) had no significant impact. After univariate analysis, the use of a stent with diameter < 8 mm (HR 8.5, 95%CI 3.24–14.22; P < .001) was negatively associated with primary patency. Conclusions The use of self-expanding covered stents provided excellent early and mid-term results in the treatment of obstructive disease of the EIA, also in cases of high EIA tortuosity and high grade of calcifications. The use of a < 8 mm-diameter stent was associated with a reduced primary patency.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outcomes of Self-Expanding Covered Stents for the Treatment of External ILIAC Artery Obstructive Disease

Squizzato

Rey

Al-Sibbai

et al. 2023

Cardiovasc Intervent Radiol

Self Cite

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“…On the other hand, balloon-mounted stents are deployed for lesions that require a strong supporting force and a strictly precise placement. To prevent thromboembolism and artery rupture, covered stents may be suitable (15). However, there is no clinical evidence of a signi cant advantage of one type of stent over the other based on long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Long-term Outcomes of Different Crossing Strategies for the Endovascular Treatment of Complex Iliac Artery Chronic Total Occlusions

Zhang

Niu

et al. 2020

Preprint

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Purpose To explore the optimal crossing approach (antegrade versus retrograde) for iliac artery chronic total occlusions (CTOs) and to examine the long-term outcomes. Materials and Methods We performed a study on 107 patients (116 iliac occlusive lesions, mean age 64.0±11.1, 88 men) who underwent an iliac CTO endovascular intervention attempted with the use of both crossing strategies but were managed with one final crossing approach between August 2012 and August 2018. Baseline data, procedural characteristics, and outcomes were described. A Cox proportional hazard model and Kaplan-Meier method were developed to assess the differences in the two crossing approaches in terms of the 1-year and 5-year primary patency rates, TLR (target lesion revascularization) and MALEs (major adverse limb events). Results CIA (common iliac artery) lesions were more likely to be crossed successfully in the retrograde direction (6.8% for antegrade vs. 20.9% for retrograde, p=0.005), while lesions in the CIA/EIA (external iliac artery) were more prone to be crossed successfully in the antegrade direction (58.9% for antegrade vs. 39.5% for retrograde, p=0.016). Considering EIA lesions, there were no significant differences in the crossing approach between the two groups. The two crossing approaches were associated with similar estimates of 1- and 5-year primary patency, TLR and MALE rates. Conclusion The antegrade approach was associated with a higher rate of successful crossing in CIA/EIA CTO lesions, while the CIA-only CTOs were more likely to be crossed successfully with the retrograde approach.

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Use of the Outback re-entry device for occluded abdominal aortic aneurysms with bilateral common iliac artery aneurysms

Kuwada,

Kanaoka,

Yunoki

et al. 2023

Annals of Vascular Surgery - Brief Reports and Innovations

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Midterm Results of Endovascular Treatment for Complete Iliac Axis Occlusions Using Covered Stents

Cited by 8 publications

References 31 publications

Outcomes of Self-Expanding Covered Stents for the Treatment of External ILIAC Artery Obstructive Disease

Outcomes of Self-Expanding Covered Stents for the Treatment of External ILIAC Artery Obstructive Disease

Effectiveness and Long-term Outcomes of Different Crossing Strategies for the Endovascular Treatment of Complex Iliac Artery Chronic Total Occlusions

Use of the Outback re-entry device for occluded abdominal aortic aneurysms with bilateral common iliac artery aneurysms

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