Abstract
AimTo assess the technical feasibility and clinical outcome of percutaneous transluminal angioplasty (PTA) with and without stent placement for treatment of buttock claudication caused by internal iliac artery (IIA) stenosis.MethodsBetween September 2001 and July 2011, thirty-four patients with buttock claudication underwent endovascular treatment. After angiographic lesion evaluation PTA with or without stent placement was performed. Technical success was recorded. Clinical outcome post-treatment was assessed at three months post-intervention and was classified as: 1) complete relief of symptoms, 2) partial relief, or 3) no relief of symptoms. Complications during follow-up were recorded.ResultsForty-four lesions in 34 symptomatic patients were treated with PTA. Eight lesions were treated with additional stent placement. Technical success was achieved in 40/44 lesions (91%). Three procedure-related minor complications occurred, i.e. asymptomatic conservatively treated intimal dissections. After a median of 2.9 months, patients experienced no relief of symptoms in 7/34 cases (21%), partial relief in 14/34 cases (41%), and complete relief in 13/34 cases (38%). Six patients required a reintervention during follow-up.ConclusionEndovascular treatment of IIA stenosis has a high technical success rate and a low complication rate. Complete or partial relief of symptoms is achieved in the majority (79%) of patients.
Highlights
Internal iliac artery (IIA) stenosis may lead to symptoms including pain in the buttocks or hips, extending to the upper leg [1]
The pain can be difficult to differentiate from coxarthrosis or neurogenic claudication [2,3]
A few studies with limited number of patients assessed the clinical outcome of endovascular treatment of patients with buttock claudication due to internal iliac artery stenosis [7]
Summary
Internal iliac artery (IIA) stenosis may lead to symptoms including pain in the buttocks or hips, extending to the upper leg [1]. The pain can be difficult to differentiate from coxarthrosis or neurogenic claudication [2,3]. Upon clinical suspicion of IIA stenosis, an ankle brachial pressure index can be normal as this does not include, or may not optimally visualize, the whole IIA. Color flow duplex ultrasonography (DUS) and computed tomography angiography (CTA) and/or magnetic resonance angiography (MRA) can confirm the presence of an isolated IIA stenosis or a combined IIA stenosis with stenotic inflow of the common iliac artery [4]. Treatment options range from a) conservative management including exercise therapy, life-style changes, and antiplatelet therapy, to b) minimally invasive endovascular treatment, i.e
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