Value of stent placement during percutaneous transluminal angioplasty of the iliac arteries

Background. To determine the benefits of stents during percutaneous translu minal angioplasty (PTA) of the iliac arteries. Retrospective analysis of ou r 10-year surgical experience with iliac PTA from 1988-1997 permitted compa rison of results during two consecutive periods: an initial period (1988-19 92), during which stents were never used, followed by a second period (1992 -1997), when stenting was performed on indication. Methods. From January 1988 to October 1997, 287 iliac PTA procedures (158 c ommon iliac arteries, 129 external iliac arteries) were performed on 250 pa tients. Thirty-seven patients had two iliac lesions that were treated simul taneously. Indications for PTA included stenosis (270 cases) and chronic oc clusion (17 cases). Thirty-one patients (12.4%) underwent infra-inguinal by pass in addition to PTA owing to the existence of arterial lesions at two l evels. Two consecutive patient groups were defined: Group I consisted of 75 patients who underwent 86 iliac PTA procedures between January 1988 and Ma y 1992 without stent placement; Group II consisted of 175 patients who unde rwent 201 iliac PTA procedures between June 1992 and October 1997, when sel ective stenting was performed. A total of 55 stents (35 in the common iliac artery, 20 in the external iliac artery) were placed in Group II during PT A due to unsatisfactory immediate results (dissection, residual stenosis) o r occlusion. Results. There was no 30-day mortality. There were 15 immediate failures of PTA: 8 in Group I (10.7%) and 7 in Group II (4%). The cumulative initial s uccess rate was 94%. Follow-up ranged from 3 months to 102 months (mean 37 months). The cumulative primary patency rate at 4 years was 62% (58% in Gro up I, 64% in Group II). The cumulative secondary patency rate at 4 years (i ncluding patients who subsequently underwent repeat angioplasty procedures) was 72% (68% in Group I, 74% in Group II). Conclusions. Stents were an effective means for treatment of initial failur es of PTA in patients with iliac artery occlusive disease. However, there w ere no significant differences in the long term results between PTA alone a nd PTA with selective stent placement.