title: Aortoiliac insufficiency: long-term experience with stent placement for treatment.
abstract: OBJECTIVE
  To establish and report the authors' experience with the long-term outcomes of aortoiliac stent placement for treatment of chronic lower-extremity ischemia.
  
  
  METHODS
  Stents were placed in 505 arterial segment lesions in 365 patients who presented with symptoms of chronic leg ischemia between February 1992 and March 2001. The 505 treated lesions were 88 occlusions and 417 stenoses. Indications for stent placement were claudication in 312 (62%), rest pain in 107 (21%), ulcer in 67 (13%), and gangrene in 19 (4%) arterial segments. Patients were followed up for up to 105 months (mean, 33 months +/- 27 [SD]).
  
  
  RESULTS
  Hemodynamic success was achieved in 484 (98%) of the 496 limbs for which postprocedural translesion pressure gradients were available. Mean ankle-brachial indexes improved from 0.53 +/- 0.25 to 0.79 +/- 0.23 (P <.001). Major complications were seen in 24 (7%) patients. Two patients (0.5%) died within 30 days after stent placement. Twenty (6%) of 355 patients underwent aortic or iliac bypass surgery during the follow-up period. Eight years after stent placement, primary patency was 74%; primary assisted patency, 81%; and secondary patency, 84%. Variables associated with better patency included stenosis (rather than occlusion), shorter lesion length, older age, and limb-threatening ischemia. At the last follow-up examination, 74% of the 466 limbs for which follow-up clinical status data were available were asymptomatic, 22% were associated with claudication, 3% were associated with rest pain, and 1% were associated with ischemic tissue loss. Five patients underwent amputation on the ipsilateral side after stent placement.
  
  
  CONCLUSIONS
  Findings from long-term experience with aortoiliac stent placement for treatment of chronic lower-extremity ischemia confirmed the procedure to be a durable, low-risk revascularization option.
authors.affiliation: Division of Vascular and Interventional Radiology, Department of Diagnostic Imaging, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903, USA.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Murphy
authors.forename: Nikki S
authors.initials: NS
authors.lastname: Ariaratnam
authors.forename: Wilfred I
authors.initials: WI
authors.lastname: Carney
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Marcaccio
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Slaiby
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Soares
authors.forename: H Myra
authors.initials: HM
authors.lastname: Kim
mesh_terms: D000368:Aged; D001011:Aorta / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D007383:Intermittent Claudication / Q000601:surgery; D007511:Ischemia / Q000601:surgery; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis; D013995:Time; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology