STENTING WITHOUT THROMBOLYSIS FOR AORTOILIAC OCCLUSIVE DISEASE - EXPERIENCE IN 14 HIGH-RISK PATIENTS

Stenting without thrombolysis of 16 occluded iliac artery segments and one occluded infrarenal abdominal aorta was attempted in 14 patients. All patients were either considered to be prohibitive operative risks or had contraindications to thrombolytic therapy. Indications for lim b reperfusion included rest pain, disabling claudication, or dry gangr ene. Successful recanalization was achieved primarily in 13 patients w ith self-expandable Wallstents, balloon-expandable Palmaz stents, or a combination of the two stents. Follow-up was carried out in all patie nts in whom recanalization was successful. All stented patients showed symptomatic improvement, and the mean preprocedure ankle/brachial ind ex, which was 0.31, improved to 0.78 after the procedure (p = 0). Comp lications included a vertebrobasilar stroke during the procedure in on e patient, perforation during angioplasty of a stenotic but nonocclude d external iliac artery in one, and dissection of the distal external iliac artery in one. Distal embolization did not occur. Percutaneous r ecanalization of aortoiliac occlusions without initial thrombolysis is possible and has a high potential for technical success. Additional d ata and longer follow-up are still needed, but this procedure may prov ide a reasonable, less invasive option in some patients at high surgic al risk or in patients who have contraindications to thrombolytic ther apy.