Aortoiliac Stent Research Articles

Intra-aortic balloon pump placement following aorto-iliac angioplasty and stent placement

Intra-aortic balloon pump placement following aorto-iliac angioplasty and stent placement

External iliac artery–to–internal iliac artery endograft: A novel approach to preserve pelvic inflow in aortoiliac stent grafting

Purpose: To describe four patients with abdominal aortic aneurysm and bilateral common iliac artery aneurysms repaired by coil embolization of the ipsilateral internal iliac artery, aortouniiliac endograft extended to the ipsilateral external iliac artery, femorofemoral bypass grafting, and a contralateral external iliac to internal iliac stent graft to preserve pelvic perfusion. Methods: Four patients with multiple risk factors, abdominal aortic aneurysm (mean diameter, 6.6 cm), and bilateral common iliac artery aneurysms were evaluated with contrast-enhanced computed tomography scanning, arteriography, and intravascular ultrasonography. Aortobiiliac endovascular abdominal aortic aneurysm repair was not feasible because of extension of the common iliac artery aneurysms to the iliac bifurcation bilaterally. Results: The abdominal aortic aneurysms were repaired with an aortouniiliac endograft. The ipsilateral common iliac artery aneurysms were treated by coil embolization of the internal iliac artery and extension of the endograft to the external iliac artery. The contralateral common iliac artery aneurysms were excluded by a custom-made stent graft (n = 2) or a commercial stent graft (n = 2) from the external iliac artery to the internal iliac artery, which preserved pelvic inflow via retrograde perfusion from the femorofemoral bypass. Mean length of stay was 3.5 days. One patient had hip claudication. Follow-up (mean 10 months, range 6 to 17) demonstrated exclusion of the abdominal aortic aneurysm and common iliac artery aneurysms with no endoleak and patent external iliac artery–to–internal iliac artery endografts in all patients. Conclusion: Patients with bilateral common iliac artery aneurysms that extend to the iliac bifurcation may be excluded from endovascular abdominal aortic aneurysm repair because of concerns regarding pelvic ischemia after occlusion of both internal iliac arteries. External iliac artery–to–internal iliac artery endografting is a feasible alternative to maintain pelvic perfusion and still allow endograft repair of the abdominal aortic aneurysm in these patients. (J Vasc Surg 2002;35:120-4.)

External iliac artery–to–internal iliac artery endograft: A novel approach to preserve pelvic inflow in aortoiliac stent grafting

External iliac artery–to–internal iliac artery endograft: A novel approach to preserve pelvic inflow in aortoiliac stent grafting

Percutaneous transluminal angioplasty versus primary stenting

The decision to perform primary aortoiliac stent placement or to reserve metal stents for inadequate balloon angioplasties is an important one. Unfortunately, only a single randomized control study, the Dutch Iliac Stent Trial, has examined this issue. It is important for interventionalists to recognize both the merits and deficiencies of that widely quoted work and to understand its limitations as a guide for patient care.

Aortoiliac stent deployment versus surgical reconstruction: Analysis of outcome and cost

Purpose:The purpose of this study is to compare complication rate, primary patency, and cost of stent deployment with direct surgical reconstruction for the treatment of severe aortoiliac occlusive disease. Methods:From March 1, 1992, to May 31, 1996, 119 patients receiving treatment for aortoiliac occlusive disease were analyzed after exclusions. Sixty-five patients had stent deployment and 54 patients had surgical reconstruction. Data were evaluated within and between the groups by univariate and multivariate logistic regression, life-table, t-test, and cross tabulation with χ 2 analysis. Results:There was no significant difference between the groups with regard to demographic features or presenting symptoms (all p values > 0.07). Incidence of procedure-related complications was similar ( p = 0.30). However, there were more systemic complications in the surgery group (15 versus 2; RR = 5.5, p < 0.01) and more vascular complications in the stent group (16 versus 3; RR = 12, p < 0.002). Incidence and type of late complications were not appreciably different (all p values > 0.05). Cumulative primary patency rate of bypass grafts was significantly better than stented iliac arteries at 18 months (93% versus 77%), 30 months (93% versus 68%) and 42 months (93% versus 68%); p = 0.002, log rank. Multivariate analysis identified female gender (RR = 4.6, p = 0.03), ipsilateral SFA occlusion (RR = 5.6, p = 0.01), procedure-related vascular complication (RR = 9.7, p = 0.002), and hypercholesterolemia (RR = 5.0, p = 0.02) as independent predictors of bypass graft or stent thrombosis. Mean total hospital cost per limb treated did not differ significantly between surgery and stent deployment groups ($9383 versus $8626, respectively; p = 0.66, t-test). Conclusions:Treatment of severe aortoiliac occlusive disease by surgical reconstruction or stent deployment has a similar complication rate. Mean hospital cost per limb treated is essentially equal. However, cumulative primary patency rate of bypass grafts is superior to stents. Therefore, considering the elements of cost and patency, surgical revascularization has greater value. The benchmark for cost-effective treatment of severe aortoiliac occlusive disease is direct surgical reconstruction. (J Vasc Surg 1998;28:94-103.)

Aortoiliac Stent Placement in Patients Treated for Intermittent Claudication

To assess the results of iliac artery stent placement for the treatment of patients with intermittent claudication. Lesions in 90 iliac arteries were treated in 65 patients with 111 Wallstents and 21 Palmaz stents. Stents were placed for symptoms of intermittent claudication classified as grade I, categories 1-3 by the SVS/ISCVS/SCVIR reporting standards. Sixty-two stenosed arteries and 28 chronically occluded arteries were treated. Patients were followed for up to 57.1 months (mean, 17.4 months +/- 14.9). Technical success was achieved in 87 of 90 iliac limbs (97%), with major complications in seven of 65 patients (11%). The 30-day mortality was zero. Mean pressure gradients across stenoses improved from 14.7 mm Hg +/- 9.8 to 1.4 mm Hg +/- 1.4 (P < .001). Ankle-brachial indices improved from 0.62 +/- 0.21 to 0.90 +/- 0.18 (P < .001). With use of the Rutherford criteria, 84% demonstrated +2 or +3 improvement. The cumulative patency rates were 77%, 71%, 62%, and 62% at 1, 2, 3, and 4 years (standard error [SE] < 10%). Continued clinical and noninvasive test benefit was present in 80%, 80%, 73%, and 73% at 1, 2, 3, and 4 years, respectively (SE < 10%). Significant hemodynamic improvement can be achieved by percutaneous stent placement, with excellent clinical results. Observed mortality in this series was zero, but major complications, requiring modification of the treatment plan, were seen in 11% of patients. Clinical results were better than suggested using current accepting reporting standards for "patency."

Midaortic pseudoaneurysm complicating extensive endovascular stenting of aortic disease

We report a case of successful surgical management of a potentially life-threatening complication of aortoiliac stent placement. A 59-year-old man who had Leriche syndrome underwent bilateral iliac artery and infrarenal aortic stent placement at another institution. His history was significant for retroperitoneal lymph node dissection at 19 years of age for testicular cancer. One week after stent placement, the patient was readmitted with abdominal pain, poor oral intake, and diffuse intermittent tenderness. Evaluation with computed tomographic scanning and endoscopy was unremarkable, and the patient was discharged. He was admitted to our institution 1 week later with persistent abdominal pain. A computed tomographic scan of the abdomen revealed a large pseudoaneurysm of the abdominal aorta. The patient underwent urgent exploration, and exclusion of his infrarenal aorta was achieved with aortobifemoral bypass grafting. After the operation, the patient's course was complicated by a large paraduodenal hematoma, which resulted in a gastric outlet obstruction, which was managed without operation. This case illustrates a potential life-threatening complication of extensive stent placement for aortoiliac occlusive disease. Injury to the abdominal aorta must be considered in a symptomatic patient after the placement of stents in the aortoiliac region, beyond the immediate periprocedural period. (J Vasc Surg 1997;26:958-62.)

Aortoiliac occlusion treated by a combination of aortoiliac stent and femorofemoral crossover grafting

Aortoiliac occlusion treated by a combination of aortoiliac stent and femorofemoral crossover grafting