PERCUTANEOUS REVASCULARIZATION OF COMPLEX ILIAC ARTERY STENOSES AND OCCLUSIONS WITH USE OF WALLSTENTS - 3-YEAR EXPERIENCE

PURPOSE: To assess the outcome of percutaneous placement of Wallstents for treatment of hemodynamically significant diffuse stenoses (> 3 cm in length), chronic occlusions, failed angioplasty procedures, and fl ow-limiting dissection in the iliac arteries. MATERIALS AND METHODS: L esions in 94 iliac limbs were treated in 66 patients. Indications for stent placement included claudication in 49 limbs and limb-threatening ischemia in 45. Forty-two limbs were treated for diffuse disease, 39 for chronic occlusion, nine for failed angioplasty, and four for flow- limiting dissection. RESULTS: Technical success was achieved in 86 of 94 limbs (91%), with major complications in 9% of patients. One death occurred within 30 days (not procedure-related). Ankle-brachial indexe s improved from 0.51 +/- 0.24 to 0.76 +/- 0.22 (P < .001). Eighty-five percent demonstrated improvement under Rutherford criteria. Follow-up was obtained up to 38 months (mean, 14 months +/- 8). Cumulative prim ary patency rates were 78% at 1 year and 53% at 2 and 3 years (standar d error 10%). Secondary patency rates were 86% at 1 year and 82% up to 32 months (standard error > 10% after 32 months). No significant decr ease in mean ankle-brachial index was observed during follow-up. No di fference in primary patency was observed based on lesion type, symptom severity, lesion location, or runoff status. The limb salvage rate fo r patients with limb-threatening ischemia was 98% at a mean follow-up of 14 months +/- 7. CONCLUSIONS: Technical success and complication ra tes for percutaneous iliac artery revascularization with use of Wallst ents are favorable, symptoms improved in the majority of patients, and excellent secondary patency can be achieved. With use of Wallstents, most patients with iliac artery insufficiency as a result of long-segm ent disease or chronic occlusions can be treated percutaneously.