Stent-supported recanalization of chronic iliac artery occlusions

PURPOSE: Iliac artery occlusions that are more than a few centimeters in le ngth are normally treated with surgical bypass grafting. The aim of this st udy was to evaluate the results of primary stent implantation after Excimer laser-assisted recanalization of iliac artery occlusions. SUBJECTS AND METHODS: We studied 212 consecutive patients with chronic unil ateral iliac artery occlusions (mean [+/- SD] length 8.9 +/- 3.9 cm) who we re treated with Excimer laser-assisted recanalization and stent implantatio n. Based on the criteria of the Society of Cardiovascular and Interventiona l Radiology, lesions were graded as class III occlusions (<5 cm) in 46 pati ents and as class IV (<greater than or equal to>5 cm) in 166 patients. A to tal of 527 stents (Palmaz stent, 346; Wallstent, 94; Strecker stent, 38; co vered stents, 49) were implanted. RESULTS: Technical success was achieved in 190 (90%) patients. There was a clinical improvement of three grades in 112 (53%) patients and of two grade s in 67 (32%) patients. The rate of major complications was 1.4%, which inc luded arterial rupture (1) and embolic events (2). Primary patency rates we re 84% at 1 year, 81% at 2 years, 78%, at 3 years. and 76% at 4 years. Seco ndary patency rates were 88% at 1 year, 88% at 2 years, 86% at 3 years, and 85% at 4 years. CONCLUSION: Stent-supported angioplasty is an effective treatment for iliac artery occlusions, with less morbidity and mortality than is associated wi th surgery. However, reported long-term patency rates after bypass surgery are greater than those we observed with interventional treatment. The value of primary stenting as compared with angioplasty alone should be evaluated in a randomized trial. Am J Med. 2001;110:708-715. (C) 2001 by Excerpta Me dica, Inc.