title: Outcomes of the Endovascular Treatment of Stenotic Lesions versus Chronic Total Occlusions in the Iliac Sector.
abstract: BACKGROUND
  This study compares outcomes of the endovascular treatment (EVT) of iliac artery occlusive disease according to whether the treated lesion is a stenosis or a chronic total occlusion (CTO).
  
  
  METHODS
  Patients undergoing EVT from 2003 to 2013 for iliac artery occlusive disease were identified and the lesions treated stratified into stenotic (Group 1, n = 375) or CTO (Group 2, n = 87). Patients were followed clinically and hemodynamically (thigh-brachial index, TBI). Comorbidities, procedural factors, and outcomes were compared between the 2 groups using Kaplan-Meier, Breslow, and Cox models.
  
  
  RESULTS
  Four hundred sixty-two iliac endovascular procedures in 378 patients were included in a retrospective study. The 2 groups only differed in preprocedural TBI [0.77 (Group 1) vs. 0.67 (Group 2), P < 0.001], lesion length [39.7 mm (Group 1) vs. 49.9 mm (Group 2), P < 0.001], and the use of a covered stent [11.6% (Group 1) vs. 46.2% (Group 2), P < 0.001]. The technical success rate was higher in Group 1 (99.2% vs. 89.7%, P < 0.001). Five early occlusions were recorded in Group 1 and 3 in Group 2 (1.3% vs. 3.8%, P = 0.146). Median follow-up was 34 months (1-113). At 12 and 36 months, stenotic lesions showed better primary (P1) and secondary (P2) patency rates [P1 93.0% and 85.8% vs. 83.1% and 74.7%, hazard ratio (HR) 1.90 (1.15-3.14), P = 0.018; P2 97.8% and 96.8% vs. 93.0% and 87.4%, HR 2.86 (1.39-5.90), P = 0.007] and freedom from reintervention (FFR) rates [91.6% and 83.5% vs. 84.1% and 78.9%, HR 1.51 (0.90-2.53), P = 0.132]. In a multivariate analysis, CTO showed a worse P2 than stenotic lesions [HR 2.81 (1.17-6.76), P = 0.021], yet no differences emerged in P1 [HR 1.41 (0.76-2.63), P = 0.277] or FFR [HR 1.43 (0.79-2.57), P = 0.237]. A lower preprocedural TBI was correlated with a greater risk of EVT failure in terms of patency and FFR (P < 0.05). The use of a stent shorter than 40 mm emerged as a protective factor with an HR for P1 of 3.68 (1.53-8.87) (P = 0.004).
  
  
  CONCLUSIONS
  EVT for iliac artery disease offers good outcomes in terms of long-term patency, although improved results were observed here for the treatment of stenotic lesions over CTO. Procedures performed in patients with a lower TBI and the use of a stent >40 mm were related to a worse stent patency.
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain. Electronic address: dr.revuelta@gmail.com.
authors.forename: Sergio
authors.initials: S
authors.lastname: Revuelta Suero
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain.
authors.forename: Isaac
authors.initials: I
authors.lastname: Martínez López
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain.
authors.forename: Manuela
authors.initials: M
authors.lastname: Hernández Mateo
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Marqués de Marino
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain.
authors.forename: Iñaki
authors.initials: I
authors.lastname: Cernuda Artero
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain.
authors.forename: Maday
authors.initials: M
authors.lastname: Cabrero Fernández
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Serrano Hernando
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003251:Constriction, Pathologic; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D065840:Protective Factors; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency