Midterm Outcomes of Stent Placement for Long-segment Iliac Artery Chronic Total Occlusions: A Retrospective Evaluation in a Single Institution

Abstract

PurposeTo assess the clinical and patency results of stent placement for long-segment iliac artery chronic total occlusions (CTOs). Materials and MethodsA retrospective analysis of 217 patients (141 men and 76 women; mean age, 76.6 y; 256 limbs) with long-segment (>5cm) iliac artery CTOs treated with stent placement was conducted in a single institution from January 2005 to July 2011. Demographics, clinical presentation, classification, comorbidity, ankle-brachial index (ABI) before and after treatment, technical success, patency, and complications were recorded at follow-up. The approach was initial access from the left brachial artery or the contralateral femoral artery. ResultsAccording to the TransAtlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) classification, 27 patients were type B, 143 were type C, and 47 were type D. Clinical presentation was recorded according to the Rutherford-Becker classification: 35 patients presented with stage 3; 108, with stage 4; 53, with stage 5; and 21, with stage 6. Technical success was 96.5% (247 of 256). Periprocedural in-stent thrombosis occurred in nine patients and was treated successfully with catheter-directed thrombolysis. ABI increased from 0.36±0.16 (range, 0–0.57) before the procedure to 0.79±0.24 (range, 0.56–1.12) after the procedure. The mean duration of follow-up was 25.4 months (range, 1–72 months). The primary, primary assisted, and secondary patency of the iliac artery was 95.1%, 98.4%, and 99.2% at 1 year and 91.9%, 95.6%, and 97.5% at 2 years, respectively. Major complications were encountered in 17 (6.6%) patients, and minor complications occurred in 12 (4.7%) patients. ConclusionsThese data suggest that stent placement is an effective, safe, and feasible method for treating long-segment iliac artery CTOs.