title: Mid-term outcomes following endovascular re-intervention for iliac artery in-stent restenosis.
abstract: OBJECTIVE
  We sought to evaluate the procedural characteristics and clinical outcomes of endovascular repair for iliac artery (IA) in-stent restenosis (ISR).
  
  
  BACKGROUND
  An increasing percentage of patients with complex IA occlusive disease are treated with an endovascular approach, but the outcomes of IA-ISR have not been well described.
  
  
  METHODS
  We analyzed all endovascular procedures for treatment of IA-ISR performed at our institution between July 2006-December 2010. The primary outcome was primary patency, defined as <50% stenosis as assessed by clinical examination and duplex ultrasonography (DUS).
  
  
  RESULTS
  Forty-one lesions in 24 patients who underwent repeated endovascular intervention for treatment of IA-ISR. Most lesions were unilateral and involved the common IA (66%). The mean length of ISR was 30.1 ± 14.1 mm with type I (focal) and II (diffuse) ISR occurring with the greatest frequency (34% and 39%, respectively). All patients underwent balloon angioplasty; adjunctive stenting zwas performed in 27 (66%) of the lesions. Type II ISR lesions more frequently required stenting (13/16 lesions, P = 0.02 compared with other patterns of ISR). Procedural success was 100% with a mean gain of 0.13 in the ankle-brachial index (P = 0.001). The 6- and 12-month primary patency rates were 96% and 82%, respectively. The 12-month primary-assisted patency rate was 90% with clinically driven target lesion revascularization (TLR) in three patients.
  
  
  CONCLUSIONS
  Endovascular treatment of IA-ISR using an approach of balloon angioplasty followed by selective stenting is associated with high-patency rates and low rates of TLR at 1 year.
authors.affiliation: Division of Cardiovascular Medicine and The Vascular Center, Davis Medical Center, University of California, Sacramento, California.
authors.forename: Usman
authors.initials: U
authors.lastname: Javed
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Balwanz
authors.forename: Ehrin J
authors.initials: EJ
authors.lastname: Armstrong
authors.forename: Khung-Keong
authors.initials: KK
authors.lastname: Yeo
authors.forename: Gagan D
authors.initials: GD
authors.lastname: Singh
authors.forename: Satinder
authors.initials: S
authors.lastname: Singh
authors.forename: David
authors.initials: D
authors.lastname: Anderson
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Westin
authors.forename: William C
authors.initials: WC
authors.lastname: Pevec
authors.forename: John R
authors.initials: JR
authors.lastname: Laird
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D055109:Ankle Brachial Index; D002140:California; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D011859:Radiography; D012008:Recurrence; D012042:Registries; D019233:Retreatment; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency
keywords: iliac artery; in-stent restenosis; peripheral arterial disease