title: Long-term outcomes for systematic primary stent placement in complex iliac artery occlusive disease classified according to Trans-Atlantic Inter-Society Consensus (TASC)-II.
abstract: OBJECTIVE
  To compare long-term outcomes of systematic primary stent placement between Trans-Atlantic Inter-Society Consensus (TASC)-II C/D disease and TASC-II A/B disease.
  
  
  METHODS
  Between 1997 and 2009, endovascular treatments with primary stent placement were performed for 533 lesions in 413 consecutive patients with iliac artery occlusive disease. Median follow-up term was 72 months (range, 1-144 months). Lesion severity in this retrospective study was classified according to TASC-II as type A in 134 patients (32%), type B in 154 patients (37%), type C in 64 patients (16%), and type D in 61 patients (15%). Technical success rates, procedure time, complication rates, and cumulative primary patency rates were compared between the complex lesion group (TASC-II type C/D) and the simple lesion group (TASC-II type A/B). Risk factors for in-stent restenosis were also analyzed.
  
  
  RESULTS
  Technical success rates in TASC-II C/D and A/B were both 99%. Procedure times for TASC-II type A, B, C, and D lesions were 98 ± 40, 124 ± 50, 152 ± 55, and 183 ± 68 minutes, respectively. Procedure time was significantly longer in TASC-II C/D (167 ± 63 minutes) than in TASC-II A/B (112 ± 47 minutes; P < .001). The complication rate was significantly higher in TASC-II C/D (9%) than in TASC-II A/B (3%; P = .014). Cumulative primary patency rates at 1, 3, 5, and 10 years were 90%, 88%, 83%, and 71% in TASC-II C/D and 95%, 91%, 88%, and 83% in TASC-II A/B, respectively. No significant differences were apparent between groups (P = .17; Kaplan-Meier method, log-rank test). In multivariate analysis, lesion length was an independent risk factor for in-stent restenosis (hazard ratio, 1.12, P = .03; 95% confidence interval, 1.01-1.24).
  
  
  CONCLUSIONS
  Primary stent placement for complex iliac artery occlusive disease provides acceptable long-term outcomes, although the procedure takes relatively longer and is associated with a higher frequency of complications than for simple disease.
authors.affiliation: Department of Radiology, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Ichihashi
authors.forename: Wataru
authors.initials: W
authors.lastname: Higashiura
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Itoh
authors.forename: Shoji
authors.initials: S
authors.lastname: Sakaguchi
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Nishimine
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Kichikawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000503:physiopathology; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency