Focal aorto-iliac atherosclerosis amenable to endovascular interventions though considered benign carry a significant risk of cardiovascular mortality: clinical investigation.
OBJECTIVE
Peripheral arterial disease (PAD) manifested as claudication is surprisingly stable regarding limb deterioration but may indicate increased risk for cardiovascular events and death. We examined whether focal atherosclerotic iliac lesions (TransAtlantic InterSociety Consensus for The Management of Peripheral Arterial Disease-TASC II Type A,B) undergoing endovascular procedures indicate a high risk for limb and life and what is the effect of atherosclerotic risk factors in the rate of adverse outcomes.


METHODS
We examined patients undergoing iliac endovascular interventions due to TASC II Type A,B lesions causing disabling claudication during a 10-year period. Outcome in terms of limb condition and total mortality during short and long-term follow-up was evaluated.


RESULTS
One-hundred thirty-nine patients and one-hundred seventy limbs were examined. Median follow-up was 4.3 years. There were 100 (58.8%) limbs with Type A and 70 (41.2%) with Type B lesions. Primary patency was 81.2% and secondary patency 92.4%. One-hundred fifteen (67.6%) limbs were improved whereas 42 (24.7%) remained stable and 13 (7.7%) deteriorated during long-term follow-up. Major amputation was performed in 2 and minor amputation in 2 limbs resulting in 2.4% total amputation rate. Overall mortality was 22.6% and 64.5% of all deaths represented cardiovascular events. Statistical analysis revealed significant relations of total mortality with hyperlipidemia and diabetes.


CONCLUSIONS
Endovascular treatment of localized iliac lesions offers good long-term results regarding patency, clinical improvement and limb salvage. Nevertheless, even focal atherosclerosis indicates a significant risk of cardiovascular mortality. Modification of atherosclerotic risk factors early in the course of PAD may be beneficial for these patients.
Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece - ioannou@med.uoc.gr.
C
C
Ioannou
T
T
Kostas
N
N
Kontopodis
E
E
Manousaki
G
G
Chlouverakis
E
E
Kehagias
D
D
Tsetis
D000368:Aged; D000671:Amputation, Surgical; D001018:Aortic Diseases / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D002423:Cause of Death; D003920:Diabetes Mellitus / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006115:Greece; D006801:Humans; D006949:Hyperlipidemias / Q000401:mortality; D007083:Iliac Artery / Q000503:physiopathology; D007383:Intermittent Claudication / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency