Percutaneous interventions for treatment of iliac artery stenoses and occlusions

Balloon angioplasty is still the main workhorse for percutaneous interventi ons in the iliac arteries. It is simple to perform, cost-effective, and rem arkably safe. If an adequate hemodynamic result has been achieved, patency is acceptable. To monitor the quality of success, intraarterial pressure mo nitoring is an important tool. Balloon angioplasty may be followed by stent insertion in case of insufficient luminal gain after inadequate balloon an gioplasty or occurrence of significant dissection. Percutaneous treatment o f chronic iliac occlusions is technically challenging. For chronic occlusio ns (duration exceeding 3 months), balloon angioplasty alone, thrombolysis w ith subsequent balloon angioplasty, and elective stenting or mechanical pas sage of the occlusion followed by primary stent implantation have been desc ribed as alternative techniques. In case of in-stent stenosis, directional atherectomy or balloon dilatation is recommended. Stent grafts allow percut aneous exclusion of isolated iliac aneurysms, iatrogenic perforation, ruptu re, and arteriovenous fistulas, but these cases are rare. Some authors incr easingly favor the use of endoluminal graft systems for treating atheroscle rotic disease in iliac arteries, but insufficient data are available to pro ve the benefit of stent grafts in patients with atherosclerotic disease.