Immediate stenting of iliofemoral occlusive lesions: a surgeon's early experiences.
OBJECTIVE
To report the early and midterm results of balloon angioplasty and immediate stenting of atherosclerotic iliofemoral lesions in an operating room setting.


METHODS
Sixty-one patients (41 men, mean age 70 +/- 8 years, range 49 to 86) underwent balloon dilation and systematic stenting for 80 stenotic and occlusive lesions in the iliac (n = 47) and superficial femoral (n = 33) arteries in 72 limbs. One hundred two stents (63 VascuCoil, 33 Wallstent, and 6 miscellaneous) were placed. Patients were followed with serial duplex scans at 3-month intervals.


RESULTS
Initial technical success by intention-to-treat was 96.2% (77/80) (iliac: 100%, femoral: 90.9% [30/33]). There were 9 (11.3%) procedure-related complications and no deaths. Initial success by anatomic, hemodynamic, and clinical limb criteria were 100%, 95%, and 94.4%, respectively. Thirty procedures were performed for limb salvage with a success rate of 86.7%. Six patients (7 limbs) died during follow-up of unrelated causes. Fifty-nine (81.9%) limbs were available for duplex follow-up over a mean 17.7 months (range 3 to 37). Cumulative patency rates were 87.3% at 2 years for iliac stents and 66.6% at 18 months for femoral stents with an overall 2-year patency rate of 76.3%. The only independent risk factors affecting late patency were the site of angioplasty, stent diameter, lesion grade, and the preoperative ankle-brachial index. Stents placed with a diameter < or = 5 mm and > 5 mm had 1-year patency rates of 51.0% and 97.6%, respectively (p = 0.004)


CONCLUSIONS
Iliac and femoral angioplasty and immediate stenting have acceptable midterm patency rates. The patency of femoral stenting is inferior and is adversely affected by stents < or = 5 mm in diameter.
Cheng
S W
SW
Department of Surgery, The University of Hong Kong Medical Centre, Queen Mary Hospital, China. wkcheng@hku.hk
Ting
A C
AC
Lau
H
H
Wong
J
J
D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000601:surgery*; D001672:Biocompatible Materials; D001783:Blood Flow Velocity; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
D001672:Biocompatible Materials