title: Efficacy of stent-supported subintimal angioplasty in the treatment of long iliac artery occlusions.
abstract: BACKGROUND
  Subintimal angioplasty (SA) is becoming increasingly accepted as a revascularization technique for chronic arterial occlusive disease. However, its efficacy in iliac artery occlusions has not been established. Therefore, we investigated the procedural and clinical outcomes of subintimal angioplasty in long iliac artery occlusions and compared them with those of intraluminal angioplasty (IA) in nonocclusive stenotic iliac artery lesions.
  
  
  METHODS
  We retrospectively analyzed data from 151 consecutive patients with long (>5 cm) iliac artery lesions (204 limbs) who underwent angioplasty with primary stent implantation from October 2004 through July 2008. Among them, 100 lesions in 100 patients were treated with intentional SA, and 104 lesions in 82 patients were treated with IA. We compared the baseline characteristics and immediate and long-term outcomes of iliac artery lesions treated with SA versus IA.
  
  
  RESULTS
  Baseline characteristics showed that longer lesions and critical limb ischemia were found more frequently in the SA group, whereas diabetes and combined femoropopliteal lesions were present more often in the IA group. The technical success rate of SA was lower than that of IA (93.0% vs 99.0%; P = .048). However, there was no significant difference in the procedure-related complications between the SA and IA groups (4.0% vs 4.8%; P = .779). Primary patency rates for SA and IA were 96.8% and 98.0% at 1 year, and 93.9% and 90.6% at 2 years, respectively (log rank P = .656).
  
  
  CONCLUSIONS
  Stent-supported SA in occlusive iliac lesions was safe and showed a high long-term patency rate comparable to that of IA performed in nonocclusive iliac lesions despite longer lesion length. Thus, SA with implantation of stents is an effective technique for the treatment of chronic long iliac artery occlusion.
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
authors.forename: Young-Guk
authors.initials: YG
authors.lastname: Ko
authors.forename: Sanghoon
authors.initials: S
authors.lastname: Shin
authors.forename: Kwang Joon
authors.initials: KJ
authors.lastname: Kim
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Kim
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.forename: Won-Heum
authors.initials: WH
authors.lastname: Shim
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000295:instrumentation* / Q000379:methods; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency