Primary stent placement for chronic iliac artery occlusions: follow-up results in 103 patients.

Vorwerk, Dierk; Guenther, Rolf W.; Schürmann, K.; Wendt, G.; Peters, Ilse

doi:10.1148/radiology.194.3.7862973

Cited by 205 publications

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“…However, rapid advances in endovascular surgery have significantly changed the patterns of vascular reconstruction. Recent studies on stenting for iliac artery stenosis and occlusion show 3-year primary patency rates of 69% to 92% and 64% to 90%, respectively [18][19][20][21][22] , whereas the 2-year primary patency rate of stenting for superficial femoral artery stenosis or occlusion is reported to be 60% to 69%. [23][24][25][26] However, endovascular surgery has less favorable outcomes for some lower extremity arteries, such as the common femoral and deep femoral arteries.…”

Section: Discussionmentioning

confidence: 99%

Hybrid Endarterectomy and Endovascular Therapy in Multilevel Lower Extremity Arterial Disease Involving the Femoral Artery Bifurcation

Zou

Xia

Yang

et al. 2012

International Surgery

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The objective of this study was to evaluate the feasibility and efficacy of hybrid therapy (combined endarterectomy-endovascular) in patients with complex peripheral multifocal steno-obstructive vascular disease involving the femoral artery bifurcation. Forty-one combined procedures were performed on 40 patients. Although the common femoral artery was usually treated with endarterectomy, endoluminal procedures were performed proximally in 12 patients (group 1), distally in 18 patients (group 2), and both upward and downward in 11 patients (group 3). Patients underwent clinical assessment and anklebrachial index measurement thereafter. Primary, assisted-primary, and secondary patency rates at 24 months were 59%, 66%, and 72%, respectively. Primary patency rates were lower in group 3 compared with groups 1 and 2 (P = 0.015). The limb salvage rate was 86.4% at the end of the follow-up period. Hybrid procedures provide feasible and effective treatment management of selected patients with multilevel lower extremity arterial disease involving the femoral artery bifurcation.Key words: Endarterectomy -Interventional radiography -Arteriosclerosis obliteransFemoral artery T he indications for the endovascular treatment of peripheral arterial disease have rapidly increased since the introduction of percutaneous transluminal angioplasty (PTA) and stenting. 1,2 The advantages of the endovascular approach include lower periprocedural morbidity and mortality. Short-term data from Bypass versus Angioplasty trials in Severe Ischemia of the Leg (BASIL) have confirmed this, with similar clinical outcome for the surgical and endovascular approach. Considerable progress has also been made in the endovascular treatment of infrapopliteal arterial occlusion. One study has demonstrated that infrapopliteal angioplasty is a reasonable primary treatment for critical limb ischemia patients with TransAtlantic InterSociety Consensus (TASC) A, B, or C lesions. 4 Due to the multilevel nature of peripheral arterial disease, iliac or femoral lesions accompanied by the femoral artery bifurcation (FB) disease are frequently observed. 5,6 Endovascular surgery is poorly suited to treating lesions in the FB because they are bulky and eccentric. In addition, the location of the lesions makes ipsilateral access difficult and stent placement impossible. As with the common femoral artery, the deep femoral artery is not generally favorable for endovascular surgery because it usually has either an orifice lesion involving the FB or a diffuse lesion along the length of the artery, which is often into its secondary and tertiary branches.Simultaneous hybrid endovascular and open lower extremity arterial reconstructive procedures have the advantage of eliminating the need for major surgery and avoiding separate staged interventions and their associated morbidity. Recently, several investigators have published results on several types of combined treatments for various patterns of iliac, femoral, and infrapopliteal diseases with promising outcomes.7-14 Mos...

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Section: Discussionmentioning

confidence: 99%

Hybrid Endarterectomy and Endovascular Therapy in Multilevel Lower Extremity Arterial Disease Involving the Femoral Artery Bifurcation

Zou

Xia

Yang

et al. 2012

International Surgery

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“…Moreover, recently published data from animal investigations did not show significant differences regarding neointimal hyperplasia between the Palmaz stunt, Wallstent,andMemothermstuntin iliac arteries [31]. We acknowledgethat the number of stunts included in our investigation is rela tively small compared with the number of iliac arterial stunts in other studies [1, 4,5,7,19,21,22]. However, this is the first systematic in travascular sonography follow-up investiga tionof Memothermstunts to ourknowledge.…”

Section: Resultsmentioning

confidence: 66%

“…The Strecker stunt (Boston Scien tific), a balloon-expanthble stunt made of knit ted tantalum wire, is more flexible and elastic comparedwith the Palmaz stunt and has corn parable patency rates in iliac arteries [5,20]. The first self-expanding stunt used in clinical practice for treatment of iliac artery stenosis or occlusionwith a 2-yearpatencyrateof approx imately 90% is the Wallstent (Schneider, Zur ich, Switzerland), a flexible and compliant stunt made of multiple stainless steel filaments [4,21,22]. All of thesestuntshavesimilar patency ratesand clinical successratesfor the iliac ar tery, and therefore the choice of stunt type is a question ofpersonal preference [23}.…”

Section: Resultsmentioning

confidence: 99%

Evaluation of maximum neointima proliferation and plaque morphology in iliac self-expanding nitinol stents with intravascular sonography.

Schwarzenberg

Müller‐Hülsbeck²,

Glüer³

et al. 1998

American Journal of Roentgenology

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OBJECTIVE. The purposeof this studywas to useintravascularsonographyto evaluate neointima formation, plaque location, and the performance of self-expanding nitinol (Mem otherm) stents in iliac arteries.SUBJECTS AND METHODS. Seventeenpatients(mean age, 64 Â±9.4 years) with stenosesor occlusions of the common (n = I 2) or external (,z = 5) iliac artery were treated with 21 Memotherm stents(mean diameter Â± SD, 8.9 Â±1.3 mm; mean length, 53 Â± 20.9 mm). Four patients had two stentseach. Intravascular sonography was performed 13 Â± 6 months af ter stent implantation. Maximum thickness of neointima and maximum cross-sectional plaque area were measured.Qualitative analysis of plaque composition and lesion topography were also assessed.RESULTS. Intravascular sonography revealed22.1% Â±17.3%maximumpercentage of rest enosis,and maximum plaqueareawas found to be I 1.2Â±10 mm2. Only hypoechogenicin-stent lesions (soft plaques)were found. Seven(33%) incomplete stent expansionsand two (10%) in completeappositionsof the stentto the vesselwall were revealedby intravascularsonography.CONCLUSION. Iliac artery Memothermstentsgenerallyshowedmoderatein-stentre stenosiswith uniform neointima distribution. Incomplete stent expansion was detected in one third of all implanted stents.

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“…DE may be treated with catheter aspiration, balloon inflation, stent placement, and occasionally, with surgical embolectomy. DE has been reported in most studies of iliac interventions; the incidence ranges from 0.4 to 9% [36][37][38][39][40].…”

Section: Complicationsmentioning

confidence: 98%

SCAI expert consensus statement for aorto‐iliac arterial intervention appropriate use

Klein

Feldman

Aronow

et al. 2014

Cathet Cardio Intervent

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Aorto‐iliac arterial occlusive disease is common and may cause a spectrum of chronic symptoms from intermittent claudication to critical limb ischemia. Treatment is indicated for symptoms that have failed lifestyle and medical therapies or occasionally to facilitate other interventional procedures such as TAVR and/or placement of hemodynamic assist devices. It is widely accepted that TASC A, B, and C lesions are best managed with endovascular intervention. In experienced hands, most TASC D lesions may be treated by endovascular methods, and with the development of chronic total occlusion devices, many aorto‐iliac occlusions may be recanalized safely by endovascular means. Interventional cardiologists should be well versed in the anatomy, as well as the treatment of aorto‐iliac disease, given their need to traverse these vessels during transfemoral procedures. Overall, aorto‐iliac occlusive disease is more commonly being treated with an endovascular‐first approach, using open surgery as a secondary option. This document was developed to guide physicians in the clinical decision‐making related to the contemporary application of endovascular intervention among patients with aorto‐iliac arterial disease. © 2014 Wiley Periodicals, Inc.

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Primary stent placement for chronic iliac artery occlusions: follow-up results in 103 patients.

Abstract: Primary stent placement should be the treatment of choice in unilateral chronic iliac artery occlusion.

Cited by 205 publications

References 0 publications

Hybrid Endarterectomy and Endovascular Therapy in Multilevel Lower Extremity Arterial Disease Involving the Femoral Artery Bifurcation

Hybrid Endarterectomy and Endovascular Therapy in Multilevel Lower Extremity Arterial Disease Involving the Femoral Artery Bifurcation

Evaluation of maximum neointima proliferation and plaque morphology in iliac self-expanding nitinol stents with intravascular sonography.

SCAI expert consensus statement for aorto‐iliac arterial intervention appropriate use

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