DOES STENT PLACEMENT IMPROVE THE RESULTS OF INEFFECTIVE OR COMPLICATED ILIAC ARTERY ANGIOPLASTY

Objective: This study was undertaken to determine the results and comp lications of stents placed for initially unsuccessful or complicated i liac percutaneous transluminal angioplasty (PTA), the effect of locati on (external iliac or common iliac) on outcome, and the influence of s uperficial femoral artery patency on benefit. Design: From 1992 throug h 1997, 350 patients underwent iliac artery PTA at the authors' instit utions. Of this group, 88 patients (88 arteries) had one or more stent s placed after PTA (140 stents in total) for residual stenosis or pres sure gradient (63 patients), iliac dissection (12 patients), long-segm ent occlusion (10 patients), or recurrent stenosis (3 patients). Thirt y patients required the placement of more than one stent. The indicati ons for PTA in these 88 patients were claudication (48 patients) and l imb-threatening ischemia (40 patients). Forty-seven patients had stent s placed in the common iliac, 29 patients had stents placed in the ext ernal iliac, and 12 patients had stents placed in both. Seventy-one ar teries (81%) were stenotic, and 17 (19%) were occluded before PTA. Six ty-six arteries were treated by interventional radiologists, 15 by a v ascular surgeon, and 7 jointly. Main outcome measure: Criteria for suc cess included (1) increase of at least one clinical category of chroni c limb ischemia from baseline or satisfactory wound healing, (2) maint enance of an ankle/brachial index increase of more than 0.10 above the preprocedure index, and (3) residual angiographic stenosis less than 25% and, for patients with pressure gradient measurements, a residual gradient less than 10 mm Hg. Results: Stent placement was accomplished in all 88 patients with 16 (18%) major complications. Mean follow-up was 17 months (range, 3 to 48 months). By life-table analysis, success was 75% at 1 year, 62% at 2 years, and 57% at 3 years. No cardiovascu lar risk factor or independent variable was statistically significant in predicting success. There was no difference in success rates for co mmon iliac or external iliac lesions. Superficial femoral artery paten cy did not correlate with outcome. Conclusions: Although stents can el iminate residual lesions and arterial dissection, these patients are L ikely to require adjuvant or subsequent procedures to attain clinical success. By controlling the PTA complication and treating the emergent problem, stents may allow for subsequent elective intervention.