Stent-supported recanalization of chronic iliac artery occlusions.
OBJECTIVE
Iliac artery occlusions that are more than a few centimeters in length are normally treated with surgical bypass grafting. The aim of this study was to evaluate the results of primary stent implantation after Excimer laser-assisted recanalization of iliac artery occlusions.


METHODS
We studied 212 consecutive patients with chronic unilateral iliac artery occlusions (mean [+/- SD] length 8.9 +/- 3.9 cm) who were treated with Excimer laser-assisted recanalization and stent implantation. Based on the criteria of the Society of Cardiovascular and Interventional Radiology, lesions were graded as class III occlusions (<5 cm) in 46 patients and as class IV (> or =5 cm) in 166 patients. A total of 527 stents (Palmaz stent, 346; Wallstent, 94; Strecker stent, 38; covered stents, 49) were implanted.


RESULTS
Technical success was achieved in 190 (90%) patients. There was a clinical improvement of three grades in 112 (53%) patients and of two grades in 67 (32%) patients. The rate of major complications was 1.4%, which included arterial rupture (1) and embolic events (2). Primary patency rates were 84% at 1 year, 81% at 2 years, 78% at 3 years, and 76% at 4 years. Secondary patency rates were 88% at 1 year, 88% at 2 years, 86% at 3 years, and 85% at 4 years.


CONCLUSIONS
Stent-supported angioplasty is an effective treatment for iliac artery occlusions, with less morbidity and mortality than is associated with surgery. However, reported long-term patency rates after bypass surgery are greater than those we observed with interventional treatment. The value of primary stenting as compared with angioplasty alone should be evaluated in a randomized trial.
Scheinert
D
D
Department of Medicine II, University of Erlangen-Nürnberg, Erlangen, Germany.
Schröder
M
M
Ludwig
J
J
Bräunlich
S
S
Möckel
M
M
Flachskampf
F A
FA
Balzer
J O
JO
Biamino
G
G
D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D002908:Chronic Disease; D003131:Combined Modality Therapy / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D007834:Lasers; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects