Technique, Complication, and Long-Term Outcome for Endovascular Treatment of Iliac Artery Occlusion

Abstract

The aim of this study was to report technical details, procedure-related complications, and results of endovascular treatment in chronic iliac artery occlusion. Between 2001 and 2008, endovascular treatments of 127 chronic iliac artery occlusions in 118 patients (8 women and 110 men; mean age, 59 years) were retrospectively reviewed. The study was based on Ad Hoc Committee on Reporting Standards (Society for Vascular Surgery/International Society for Cardiovascular Surgery Standards). All occlusions were treated with stent placement with or without preliminary balloon angioplasty. Kaplan-Meier estimators were used to determine patency rates. Univariate and multivariate analyses were performed to determine variables affecting successful recanalization, major complications, early stent thrombosis (<or=30 days), and primary and secondary patency rates. Initial technical success was achieved in 117 (92%) procedures. Successful recanalization was obtained by antegrade approach in 69 of 77 (90%) procedures and by retrograde approach in 52 of 105 (50%) procedures (p < 0.001). Complications were encountered in 28 (24%) patients [minor in 7 patients (6%) and major in 22 patients (19%)]. One death occurred in the operative period secondary to iliac artery rupture. Early stent thrombosis was seen in eight (7%) patients. Presence of critical limb ischemia (p = 0.03), subintimal recanalization (p = 0.03), and major complication (p = 0.02) were the independent predictors of early stent thrombosis on multivariate analysis. Primary and secondary patency rates at 5 years were 63 and 93%, respectively. Presence of critical limb ischemia, TASC type C iliac lesions, combined occlusions of both common and external iliac arteries, and major complications were associated with decreased patency rates on univariate analysis, whereas these factors were not independent predictors of stent patency on multivariate analysis. In conclusion, endovascular treatment of iliac artery occlusion has a high technical success rate with favorable long-term patency rate. Success of recanalization increases with use of the antegrade approach and with the presence of a stump of artery before the occlusion.

Early and long-term comparison of endovascular treatment of iliac artery occlusions and stenosis

“…Several intraoperative and immediate complications were recorded, however, with a threefold increased risk of complications in group 1 that only approached significance, probably due to the low number of cases (type II statistical error). Similarly, Ozkan et al 16 reported in their large series concerning early and late results of endovascular treatment of chronic iliac occlusion a complication rate of 19%, successfully treated in most cases with an endovascular procedure. A pooled analysis of 38 studies of iliac PTA and of 18 studies of stenting 2 reported a complication rate of 2.7% and 6%, respectively; however, the results were not separately analyzed between stenoses and occlusions.…”

Subintimal angioplasty of chronic total occlusion in iliac arteries: A safe and durable option

“…2,7,10,11 Most of these series utilize intraluminal techniques to traverse the iliac obstruction, with a minority of lesions managed with SIA. In this study of iliac artery CTO managed exclusively with SIA, 34.7% of the lesions were graded TASC D. Although a technical success rate of 83.5% was seen in this study, the majority of these lesions were TASC C and D (61.4%), and all of these lesions were iliac artery CTOs.…”

Recanalization of flush iliac occlusions with the assistance of a contralateral iliac occlusive balloon

“…Heavy calcification and a retrograde femoral approach are risk factors for technical failure. 8 Furthermore, retrograde attempts typically require the use of expensive re-entry devices that are associated with significant costs 9 but still do not guarantee technical success. 4,8 The technique we have described here is simple but valuable in increasing technical success.…”

“…8 Furthermore, retrograde attempts typically require the use of expensive re-entry devices that are associated with significant costs 9 but still do not guarantee technical success. 4,8 The technique we have described here is simple but valuable in increasing technical success. We believe approaching these lesions by starting at the proximal cap of the iliac occlusion can increase the technical success rate because it is easier to regain true lumen access from this antegrade approach.…”