Surgical transluminal iliac angioplasty with selective stenting: Long-termresults assessed by means of duplex scanning

Purpose: The safety of iliac angioplasty and selective stenting performed i n the operating room by vascular surgeons was evaluated, and the short- and long-term results were assessed by means of serial duplex scanning. Methods: Between 1989 and 1996, 281 iliac stenotic or occlusive lesions in 235 consecutive patients with chronic limb ischemia were treated by means o f percutaneous transluminal angioplasty (PTA) alone (n = 214) or PTA with s tent (n = 67, 23.8%), There were 260 primary lesions and 21 restenosis afte r a first PTA, which were analyzed separately. Stents were implanted in sel ected cases, either primarily in totally occluded arteries or after subopti mum results of PTA (ie, residual stenosis or a dissection). Data were colle cted prospectively and analyzed retrospectively. Results were reported in a n intention-to-treat basis, Clinical results and patency were evaluated by means of symptom assessment, ankle brachial pressure index, and duplex scan ning at discharge and 1, 3, 6, and every 12 months after angioplasty. Tb id entify factors that may affect outcome, 12 clinical and radiological variab les, including the four categories of lesions defined by the Standards of P ractice Committee of the Society of Cardiovascular and Interventional Radio logy, were analyzed separately, The statistical significances of life-table analysis of patency were determined by means of the log-rank test. Results There were no postoperative deaths or amputations. Local, general, and vascular complications occurred in 2.1%, 1.3% and 4.7% of cases, respec tively (total, 8.1%). The mean folio-iv-up period was 29.6 months. The cumu lative patency rates +/- SE of the 260 PTAs (including 55 PTAs plus stents) were 92.9% +/- 1.5% at 1 month, 86.5% +/- 1.7% at: 1 year, 81.2% +/- 2.3% at 2 years, 78.8% +/- 2.9% at 3 years, and 75.4% +/- 3.5% at 5 and 6 years. The two-year patency rate of 21 redo PTAs (including II PTAs plus stents) was 79.1% +/- 18.2%. Of 12 predictable variables studied in the first PTA g roup, only the category of the lesion was predictive of long-term patency. The two-year patency rate was 84% +/- 3% for 199 category 1 lesions and 69. 7% +/- 6.5% for 61 category 2, 3, and 4 lesions together (P = .02). There w as no difference of patency in the stented and nonstented group. Conclusion: Iliac PTA alone or with the use of a stent (in cases of occlusi on and/or suboptimal results of PTA) offers an excellent long-term patency rate. Categorization of lesions remains useful in predicting long-term outc ome. PTA can be performed safely by vascular surgeons in the operating room and should be considered to be the primary treatment for localized iliac o cclusive disease.