PERCUTANEOUS ENDOLUMINAL TREATMENT OF ILIAC OCCLUSIONS - LONG-TERM FOLLOW-UP IN 105 PATIENTS

Purpose: To evaluate the long-term results of percutaneous recanalizat ion techniques in occluded iliac arteries. Methods: Percutaneous recan alization was attempted in 105 patients (97 men; mean age 56 years, ra nge 34 to 80) with iliac occlusions using thrombolysis (n = 15), excim er laser (n = 4), mechanical thrombectomy (n = 16), balloon angioplast y alone (n = 23), and angioplasty plus stenting (n = 69). The majority of lesions (n = 72) were in the common iliac artery (CIA); 33 were in the external iliac artery (EIA). Results: The primary recanalization rate was 88% (92/105) independent of location (EIA: 90%, CIA: 86%) and lesion length, but dependent on age of thrombus (< 3 months: 100%, > 3 months: 79%, p < 0.02). Complications included 5 (4.8%) cases of dis tal embolism treated by thromboaspiration or Fogarty balloon embolecto my. Seven (6.7%) early thromboses were treated surgically. Primary and secondary patency rates were calculated at 6 years for all 105 cases and for the 92 recanalized lesions using life-table analysis. Overall, primary patency was 52% (CIA: 58%, EIA: 34%) and secondary 66% (CIA: 74%, EIA: 40%). Lesions < 6 cm had a primary patency of 70%, while tho se > 6 cm had a 31% rate (p < 0.01). Secondary patencies were 86% and 42%, respectively (p < 0.01). Among recanalized lesions, the primary p atency was 61% (CIA: 69%, EIA: 38%) and secondary 77% (CIA: 88%, EIA: 45%; p < 0.05). Lesions < 6 cm had a primary patency rate of 72%, whil e longer lesions had a primary rate of 44% (p < 0.04); secondary paten cies were 89% and 59%, respectively (NS). Primary patency without sten t was 57% and with stent 65% (NS); secondary patency without stent was 71% and with stent 82% (NS). Conclusions: Percutaneous recanalization of iliac occlusions represents a true alternative to vascular surgery and a first-line treatment option. Stents have a tendency to improve long-term results and are recommended for routine use in chronic iliac occlusions.