INTRAOPERATIVE ILIAC ARTERY STENTS - COMBINATION WITH INFRAINGUINAL REVASCULARIZATION PROCEDURES

Iliac artery percutaneous transluminal angioplasty (PTA) can effective ly provide in-flow for subsequent distal vascular reconstruction. Ilia c artery stents may improve the initial hemodynamics and long term pat ency of PTA, and thus may be well-suited for combined proximal PTA wit h distal bypass procedures. This report reviews our preliminary experi ence with iliac artery stenting in combination with. infra-inguinal va scular reconstruction. Thirteen iliac artery stent procedures combined with simultaneous distal revascularization were performed in 11 patie nts. Ten procedures were performed for limb salvage, two for disabling claudication, and one before planned orthopedic surgery. Distal revas cularization procedures included seven femoropopliteal, four femorotib ial bypasses, one common femoral endarterectomy, and one thrombectomy of a femoropopliteal bypass. Stent placement was technically successfu l in all patients. Mean pre-operative ankle-brachial index (ABI) was 0 .41 (+/- 0.28), which improved to 0.91 (+/- 0.18) post-operatively (P < 0.0001). Mean systolic iliac artery gradients across the lesions imp roved from 27.1 (+/- 9.8) mm Hg to 2.7 (+/- 3.4) mm Hg after stent pla cement (P < 0.0001). Mean follow-up is 5.8 months (range 1-12 months). Two femoropopliteal bypass grafts occluded in the follow-up period. O ne occlusion was caused by a mid-vein graft stenosis that was repaired with subsequent graft patency. The other graft occlusion occurred in a patient with rest pain who did not require a second bypass procedure , as the ABI increased from 0.3 to 0.7 following stent placement with resolution of symptoms. All stents have remained patent during follow- up. Patients with limb threat all had significant clinical improvement , and no limb loss occurred. Two patients with claudication remain sym ptom free. One post-operative death occurred secondary to a myocardial infarction. Two minor wound problems and one episode of transient ren al insufficiency secondary to contrast toxicity were the only other co mplications. Iliac artery PTA with stent placement can provide adequat e inflow for subsequent distal revascularization. Furthermore, stent p lacement can be safely and effectively performed simultaneously with d istal bypass procedures in the operating room.