Tm. Sullivan et al., PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY AND PRIMARY STENTING OF THE ILIAC ARTERIES IN 288 PATIENTS, Journal of vascular surgery, 25(5), 1997, pp. 829-838
Purpose: This study reports the initial and late results of percutaneo
us transluminal angioplasty (PTA) and intravascular stenting for ather
osclerotic occlusive disease of the iliac arteries. Methods: The prepr
ocedural and postprocedural clinical records, arteriograms, segmental
limb pressure measurements (ankle-brachial [ABI] and thigh-brachial [T
BI] indexes), and pulse volume recordings of 288 patients who underwen
t PTA and primary stenting of the common iliac (354, 69.4%) and extern
al iliac (156, 30.6%) arteries were reviewed. Initial and late clinica
l, hemodynamic, and angiographic success were assessed by objective cr
iteria. Data on patients who underwent unsuccessful attempts at iliac
stent placement are unavailable; results are not reported on an intent
-to-treat basis. Results: Clinical follow-up data (mean, 11.9 months)
are available for 268 of 288 patients (93.1%) and for 394 of 424 limbs
(92.9%). The initial success rates, as determined by TBI, ABI, and cl
inical limb status, were 90.2%, 87.8%, and 74.6%, respectively. The Ka
plan-Meier estimates of angiographic patency (101 arteries) were 96%,
81%, and 73% at 6, 12, and 24 months. Cumulative patency rates were 84
%, 76%, and 57% on the basis of TBI, ABI, and clinical limb status at
24 months. Factors associated with initial success included the need f
or multiple stents (p = 0.0001), a higher degree of initial stenosis (
p 0.0001), lower severity of baseline ischemia (p = 0.007), younger ag
e (p = 0.0015), and the preprocedural patency of the ipsilateral super
ficial femoral artery (p = 0.002). A higher degree of initial stenosis
(p < 0.001) and superficial femoral artery patency (p < 0.004) were a
lso associated with late success. Conclusions: PTA and stenting of the
iliac arteries is associated with reasonable angiographic, hemodynami
c, and clinical success. The outcome is favorably affected by higher i
nitial severity of stenosis and greater extent of disease, lower sever
ity of baseline ischemia, younger age, and by patency of the ipsilater
al superficial femoral artery.