Abstract
ObjectiveThe aim of this study was to evaluate the results of endovascular therapy on the treatment of different types of iliac occlusions.Materials and methodsA bi-center prospective, non-randomized study was conducted on 100 patients (mean age 59.14 ± 8.53; 64 men) who underwent endovascular treatment of iliac occlusive disease between January 2013 and November 2017. We evaluated baseline data, procedure, and follow-up results for the entire group, and according to Trans-Atlantic Inter-Society Consensus (TASC II) classification. The majority of patients (60%) were treated for severe claudication; 56 (56%) patients had TASC B occlusions, 28 patients TASC C, and 16 patients TASC D.ResultsThe mean length of the occluded segments was 61.41 ± 35.15 mm. Procedural complications developed in 6 patients (6%). Mean ankle-brachial pressure index increased from 0.40 ± 0.12 preoperatively to 0.82 ± 0.16 postoperatively. The mean follow-up was 33.18 ± 15.03 months. After 1 and 5 years, the primary patency rates were 98% and 75.1%, and the secondary patency rate was 97% respectively. Regarding occlusion complexity there were no statistical significant differences in primary patency rates (TASC B vs. C vs. D: p = 0.19). There were no statistically significant differences in primary patency rates between patients in different clinical stages, as well as between the type of stents, and location of the occlusion.ConclusionIn our study, endovascular treatment for iliac artery occlusions proved to be a safe and efficient approach with excellent primary and secondary patency rates regardless of the complexity of occlusions defined by TASC II classification. This study is aligned with the notion that in well selected patients, endovascular therapy can be the treatment of choice even in complex iliac lesions if performed by experienced endovascular interventionists in high volume centers.
Highlights
During the last decade, the application of endovascular treatment as a therapeutic option for the aorto-iliac occlusive disease has continually increased, becoming the treatment of the first choice for many of the Trans-Atlantic Inter-Society Consensus document II (TASC II) categories [1,2]
This study is aligned with the notion that in well selected patients, endovascular therapy can be the treatment of choice even in complex iliac lesions if performed by experienced endovascular interventionists in high volume centers
European Society of Cardiology (ESC) guidelines from 2011 recommend endovascular treatment for all iliac TASC A-C lesions and TASC D lesions in patients with severe comorbidities, provided that the procedure is performed by an experienced team [4]
Summary
The application of endovascular treatment as a therapeutic option for the aorto-iliac occlusive disease has continually increased, becoming the treatment of the first choice for many of the Trans-Atlantic Inter-Society Consensus document II (TASC II) categories [1,2]. European Society of Cardiology (ESC) guidelines from 2011 recommend endovascular treatment for all iliac TASC A-C lesions and TASC D lesions in patients with severe comorbidities, provided that the procedure is performed by an experienced team [4]. Recent 2017 ESC Guidelines, in collaboration with the European Society for Vascular Surgery (ESVS), are recommending an endovascular-first strategy for aorto-iliac occlusive lesions if the procedure is performed by an experienced team and if it does not compromise subsequent surgical options [6]. These recent changes are based on expert opinions presented in the studies from high volume centers. The rationale for offering an endovascular-first option to the patient with complex lesion would be a low risk of complications and long-term patency, it is important to notice that perioperative morbidity in surgically treated patients is substantial, and the time-period before return to normal activities is shorter in endovasculary treated patients
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