TOTAL OCCLUSION OF ILIAC ARTERIES - RESULTS OF BALLOON ANGIOPLASTY

Fifty-six occluded iliac arteries (mean length 6.1 cm; range 1-17 cm) in 50 patients were treated by percutaneous transluminal angioplasty ( PTA) or laser-assisted PTA (bilateral lesions in 6 patients). Twenty-s even patients (54%) were at high risk for surgery. Patients were follo wed for a maximum period of 72 months (mean 23.12 months; median 20 mo nths). The initial success rate was 78.57% for arteries and 82% for pa tients. Laser-assisted PTA was attempted in 11 occluded arteries (19.6 4%) and was successful in 4 arteries (7.14%). Conventional PTA was suc cessful in 71.4% of arteries including all 7 arteries for which laser- assisted PTA failed (76% of patients). PTA was unsuccessful in 12 arte ries (21.43%). Urokinase was used before PTA in 1 artery. The effect o f PTA was evident clinically by relief of rest pain (66.66%), healing of ulcer (57%), increased claudication distance or no claudication (79 %) in limbs, and objectively, by improvement in ankle/arm index (AAI) (an increase of 0.16 to 0.91) and increased exercise tolerance. Contin uous improvement in AAI was observed after PTA on follow-up in 9 limbs . One patient died during follow-up. On follow-up, 3 arteries were occ luded, 6 showed evidence of stenosis, and 1 showed fusiform dilatation at the PTA site. The long-term results using the life-table method de termined a 76% primary patency rate and 81% secondary patency rate for 72 months. The overall patency including failures was 63%. Age of the patients (p = 0.0169) and hypertension (p = 0.0015) significantly aff ected the long-term patency of the artery but not the initial success. The major complications were arterial rupture in a repeat procedure i n 1 artery, axillary artery thrombosis in 1, and distal thromboembolic occlusion during PTA in 4. The long-term patency rates suggest that P TA of totally occluded iliac arteries is a safe and effective procedur e and- provides a long-term benefit.