Iliac Artery Disease Research Articles

Balloon-expandable cobalt chromium stent versus self-expandable nitinol stent for the Atherosclerotic Iliac Arterial Disease (SENS-ILIAC Trial) Trial: a randomized controlled trial.

Iliac artery angioplasty with stenting is an effective alternative treatment modality for aortoiliac occlusive diseases. Few randomized controlled trials have compared the efficacy and safety between self-expandable stent (SES) and balloon-expandable stent (BES) in atherosclerotic iliac artery disease. In this randomized, multicenter study, patients with common or external iliac artery occlusive disease were randomly assigned in a 1:1 ratio to either BES or SES. The primary end point was the 1-year clinical patency, defined as freedom from any surgical or percutaneous intervention due to restenosis of the target lesion after the index procedure. The secondary end point was a composite event from major adverse clinical events at 1year. A total of 201 patients were enrolled from 17 major cardiovascular intervention centers in South Korea. The mean age of the enrolled patients was 66.8 ± 8.5years and 86.2% of the participants were male. The frequency of critical limb ischemia was 15.4%, and the most common target lesion was in the common iliac artery (75.1%). As the primary end point, the 1-year clinical patency as primary end point was 99% in the BES group and 99% in the SES group (p > 0.99). The rate of repeat revascularization at 1year was 7.8% in the BES group and 7.0% in the SES group (p = 0.985; confidence interval, 1.011 [0.341-2.995]). In our randomized study, the treatment of iliac artery occlusive disease with self-expandable versus balloon-expandable stent was comparable in 12-month clinical outcomes without differences in the procedural success or geographic miss rate regardless of the deployment method in the distal aortoiliac occlusive lesion (ClinicalTrials.gov, NCT01834495).

Patient-specific risk factors for reintervention following primary endovascular treatment of iliac artery disease

ObjectivePredictive models for reintervention may guide clinicians to optimize selection, education, and follow-up of patients undergoing endovascular iliac revascularization. Although the impact of lesion- and device-related characteristics on iliac restenosis and reintervention risk is well-defined, data on patient-specific risk factors are scarce and conflicting. This study aimed to explore the value of patient-related factors in predicting the need for clinically driven target-vessel revascularization (CD-TVR) in patients undergoing primary endovascular treatment of iliac artery disease. MethodsConsecutively enrolled patients undergoing endovascular revascularization for symptomatic iliac artery disease at a tertiary vascular referral center between January 2008 and June 2020 were retrospectively analyzed. Primary and secondary outcomes were CD-TVR occurrence within 24 months and time to CD-TVR, respectively. Patients who died or did not require CD-TVR within 24 months were censored at the date of death or at 730 days, respectively. Multiple imputation was used to account for missing data in primary analyses. ResultsA total of 1538 iliac interventions were performed in 1113 patients (26% females; 68 years). CD-TVR occurred in 108 limbs (74 patients; 7.0%) with a median time to CD-TVR of 246 days. On multivariable analysis, increasing age was associated with lower likelihood of CD-TVR (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.50-0.83; P = .001) and decreased risk of CD-TVR at any given time (hazard ratio [HR], 0.66; 95% CI, 0.52-0.84; P = .001). Similarly, a lower likelihood of CD-TVR (OR, 0.75; 95% CI, 0.59-0.95; P = .017) and decreased risk of CD-TVR at any given time (HR, 0.73; 95% CI, 0.58-0.93; P = .009) were observed with higher glomerular filtration rates. Lastly, revascularization of common vs external iliac artery disease was associated with lower likelihood of CD-TVR (OR, 0.48; 95% CI, 0.24-0.93; P = .030) and decreased risk of CD-TVR at any given time (HR, 0.48; 95% CI, 0.25-0.92; P = .027). No associations were observed between traditional cardiovascular risk factors (sex, hypertension, higher low-density lipoprotein cholesterol, higher hemoglobin A1c, smoking) and CD-TVR. ConclusionsIn this retrospective cohort study, younger age, impaired kidney function, and external iliac artery disease were associated with CD-TVR. Traditional markers of cardiovascular risk were not seen to predict reintervention.

Clinical analysis of surgical treatment of infection after interventional operation for major iliac artery disease in 6 cases

Objective: To explore the surgical treatment strategy of stent graft infection after interventional treatment of major iliac artery related diseases. Methods: Retrospective analysis was performed on the clinical data of 6 patients with secondary stent graft infection after interventional treatment for major iliac artery related diseases admitted to the Department of Vascular Surgery,Affiliated Drum Tower Hospital,Medical School of Nanjing University from November 2021 to August 2022.There were 5 males and 1 female,with a mean age of 64 years (range:49 to 79 years).The infection time was 53 to 3 165 days.All the 6 patients received surgical treatment,including 3 patients who underwent anatomic bypass grafting (axillary arterial-femoral artery bypass,femoral arterial-femoral artery bypass) using artificial vessels,and 3 patients who underwent in situ abdominal aorta reconstruction using bovine pericardium.The perioperative situation,postoperative infection and the occurrence of serious adverse events were recorded,and the safety of different treatment methods and materials was evaluated. Results: All patients successfully completed the operation and no death occurred during hospitalization.Intraoperative blood loss was 2 000~5 000 ml,and intraoperative blood transfusion was 1 600 to 5 350 ml.All the patients were followed up for 81 to 395 days after surgery,and the incision healed well,and no reinfection occurred.Postoperative gastrointestinal bleeding occurred in 1 patient,secondary surgery (retroperitoneal hematoma removal) was performed in 1 patient due to postoperative bleeding at the vascular anastomosis,both lower limb amputations were performed in 1 patient due to postoperative lower limb ischemia,and intermittent claudication occurred in 2 patients.All patients were alive at the last follow-up. Conclusion: For patients with aortic stent graft infection,when the infection is not serious and there is enough space to block the proximal and distal aorta,in situ aortic reconstruction is an effective treatment,and different materials can achieve satisfactory results in a short period of time.

Strategies and outcomes of different methods for treating abdominal aortic stent graft infection.

To report the strategies and short-term results of different treatment methods for abdominal aortic stent graft infection. Six consecutive patients (5 males and 1 female; mean age: 64 years; age range: 49-79 years) received surgical treatment for stent graft infection from November 2021 to December 2022. All patients underwent endovascular aortic repair (EVAR) for abdominal aortic and iliac artery disease, subsequently developed graft infection and then received corresponding surgical treatment with different materials (artificial blood vessel, bovine pericardium, autologous great saphenous vein) in our department. The outcomes were analysed. Immediate technical success was achieved intraoperatively in all six patients. The 30-day mortality rate was 0%. During a mean follow-up of 4 months (range, 3-13 months), one patient underwent a second operation due to vascular anastomotic haemorrhage and underwent bilateral limb amputations due to ischaemia. All patients survived. In the short term, the different materils and methods used to treat aortic stent graft infection achieved satisfactory results.

Surgical, Endovascular, and Multimodal Approaches to the Management of Atherosclerotic Common Femoral Artery Disease.

Common femoral artery disease is at the heart of nearly all treatment algorithms and decisions for patients with symptomatic peripheral arterial disease. Surgical endarterectomy has been the mainstay of common femoral treatment with a wealth of data supporting its safety, efficacy, and durability. Advances in endovascular technology and techniques for the management of iliac and superficial femoral artery disease has resulted in a paradigm shift in management. The common femoral artery has been aptly named a "no stent zone" due to anatomic and disease-specific challenges that have limited the role for endovascular techniques. New technology and techniques in the endovascular management of common femoral disease seek to change our treatment strategies. A multimodal approach utilizing a combination of angioplasty, atherectomy, and stenting has been shown most beneficial, although limited long-term data leave durability an unanswered question. While surgical treatment remains the gold standard, advances in the endovascular approach will certainly continue to improve outcomes. As truly isolated common femoral disease is a rarity, a collaborative approach combining all benefits of open and endovascular techniques in the treatment of peripheral arterial disease is essential.

A Simple Predictor for Long-Term Mortality After Percutaneous Iliac Artery Intervention: Systemic Immune Inflammatory Index

Peripheral arterial disease is a common disease all over the world. Medical treatment, percutaneous invasive treatment, and operation are the considerable options. Percutaneous treatment is a valid option with a higher patency rate. Systemic immune-inflammatory index (SII) is a formula which is calculated as neutrophil count to platelet count divided into lymphocyte count. This formula demonstrates the active inflammatory state. In our study, we aimed to demonstrate the relationship with SII and the mortality, major cardiovascular events, and success rates of percutaneous treatment of iliac artery disease. A total of 600 patients underwent percutaneous intervention due to iliac artery disease were enrolled. The primary end point was mortality and the secondary end points were in-hospital thrombosis, restenosis, residual stenosis, and postintervention complications. The best cut-off value of SII to predict mortality was determined and the patients were divided into 2 groups, as those with higher SII values (1,073.782 <) and as those with lower SII values (1,073.782 >). Each group was evaluated in terms of clinical, laboratory, and technical aspects. After exclusion criteria were applied, 417 patients were enrolled into the study. Patients with high SII values had higher rates of in-hospital thrombosis [0 (0%); 3 (2.2%), P = 0.037] and mortality [38 (13.7%); 46 (33.1%), P<0.001]. In multivariate logistic regression analysis, chronic kidney disease [odds ratio: 4.104, 95 0.5 confidence interval: 2.250-7.487, P<0.001] and SII [odds ratio: 3.346, 95 0.5 confidence interval: 1.982-5.649, P<0.001] were found to be independent risk factors for mortality. SII is a relatively new, simple, and effective mortality risk predictor in patients with iliac artery disease who underwent percutaneous intervention. To the best of our knowledge, our study is the first study which uses SII to predict mortality in such patient group.

Five-Year Outcomes of the Bioresorbable Peripheral Remedy Stent in the Treatment of Iliac Artery Disease

PurposeTo evaluate the 5-year performance of a bioresorbable vascular scaffold, the Remedy stent, for the treatment of iliac artery atherosclerotic disease. Materials and MethodsThis prospective, multicenter, single-arm clinical study evaluated 97 patients (97 lesions) with symptomatic TransAtlantic Inter-Society Consensus II A/B iliac artery lesions for 5 years after stent placement. The primary efficacy end point was 12-month primary patency compared with the prespecified standard derived from historical data with metallic stents, and the primary safety end point was the occurrence of major adverse clinical events within 5 years. All angiographic and computed tomography angiographic findings were evaluated by an independent core laboratory for quantitative vessel analysis. ResultsThe 12-month primary patency rate was 88.6% (95% CI, 80.1%–94.4%), which was lower than the prespecified standard. No significant difference was noted between the diameter stenosis at 9 and 12 months. There were no device- or procedure-related deaths, major amputation, or distal embolization during the follow-up period. The ankle-brachial index maintained significant improvement through the 5-year period compared with that at baseline. The Kaplan–Meier estimates of freedom from target lesion revascularization (TLR), major adverse cardiovascular events, and major adverse cardiovascular and limb events were 95.8%, 91.7%, and 87.5% at 12 months and 85.4%, 72.1%, and 62.5% at 5 years, respectively. ConclusionsThe 5-year follow-up outcomes, including freedom from TLR, of the Remedy stent in iliac artery lesions were satisfactory, with a good safety profile. Nevertheless, the 12-month primary patency did not meet the expected standard compared with that of contemporary metallic stents.

Use of Secondary Iliac Branch Devices after Previous Endovascular Abdominal and Thoraco-Abdominal Aortic Aneurysm Repair

To assess the safety and effectiveness of iliac branch devices (IBDs), as secondary procedure, for the treatment of type Ib endoleak or evolution of iliac artery disease after prior endovascular aortic repair (EVAR) for thoraco-abdominal (TAAAs) or abdominal aortic aneurysms (AAAs). A multicentre observational study of three European centres. The study included 75 patients (age 71 ± 9 years, 96% men) with previous EVAR (n= 64, 85%) or fenestrated or branched (FB) EVAR (n= 11, 15%). Overall, 88 IBDs were implanted to treat aneurysmal iliac artery evolution in 40 (53%) and type Ib endoleak in 35 (47%) cases, respectively. Thirteen (17%) patients received bilateral IBDs. Internal iliac artery (IIA) catheterisation was done through a transaxillary access (n= 82, 93%) or up and over (n= 6, 7%) technique. The primary endpoint was technical success. Secondary endpoints were 30 day major adverse event, early and long term freedom from re-intervention and target vessel instability. All procedures were technically successful (100%). During hospitalisation, there were four (5%) major adverse events and three (4%) early re-interventions, but no death, stroke, or damage to previous endografts. The median follow up was 47 (interquartile range 42) months, and the five year survival rate was 78 ± 6% with no aortic related death. Cox's regression analysis showed pre-operative renal function impairment (hazard ratio [HR] 3.4; 95% confidence interval [CI] 1.1 - 10.1; p= .033), and primary TAAA repair (HR 6.1; 95% CI 1.6-22.3; p= .006) as independent factors for long term mortality. Freedom from re-interventions was 85 ± 4% at five years with 11 (12%) cases (five endoleaks, four IBD thromboses, two stenoses). IIA instability was reported in three (3%) limbs and freedom from IIA instability was 95 ± 3% after 60 months. Secondary IBD after EVAR is a safe and effective procedure with high technical success and low complication rates. The technique of choice to revascularise the IIA seems not to affect early and follow up results. Long term durability of IBD repair is acceptable with low rates of IIA re-intervention.

Critical Limb Ischemia Due to Aorto Iliac and Infrainguinal Artery Disease: Does Extensive Revascularization Warrant Limb Salvage?

Critical limb-threatening ischemia (CLTI) can be due to extensive involvement of the aorto-iliac and infrainguinal arteries. Both districts can be revascularized simultaneously to allow flow restoration in the limb; however, revascularization confined to the aorto-iliac (AI) district can be an alternative approach, to reduce operation time and invasiveness. The aim of the present study was to evaluate the limb salvage in patients with CLTI with both AI and infrainguinal peripheral artery disease (PAD) after revascularization confined to the AI district or extended also to the infrainguinal segment.

Eversion Endarterectomy – An Alternative Approach to Occlusive External Iliac Artery disease

While endovascular intervention is the recommended first option for management of common iliac artery (CIA) lesions, it lacks durable patency for Trans-Atlantic Inter-Society Consensus (TASC)-II C and D lesions involving the external iliac artery (EIA). Aorto-femoral bypass is a durable option but is unsuitable in patients with significant co-morbidities. Eversion endarterectomy provides an alternative to both endovascular and extensive open aortoiliac reconstruction for occlusive EIA disease. A single-center, retrospective review (2000-2020) of all patients undergoing eversion endarterectomy for EIA disease was undertaken. Demographic, clinical, operative and follow-up data were recorded. Fifty eversion endarterectomies were performed in 47 patients. The median age was 65.0 years (range 46-82) and 66.6% were male. Sixty-eight percent (n=34) were ASA grade 3. Indications for intervention were disabling claudication (44%) and critical limb ischaemia (56%). Angiography demonstrated 22 TASC C and 28 TASC D lesions. The median follow-up was 18.5 months (range 0-149). The technical success rate was 100%, and 84% (n=42) experienced an immediate symptomatic improvement. Primary and primary-assisted patency at one, three and five years was 86%, 82% and 74%, and 100%, 96% and 92%, respectively. The five-year limb salvage rate was 96%. Eight limbs required reintervention to maintain patency, either by open (n=2), endovascular (n=3) or hybrid approach (n=3). Thirty-day mortality was 2% (n=1) with 10% (n=5) experiencing a procedure-related morbidity. All-cause mortality was 38% (n=19) during the follow-up period. Eversion endarterectomy is a safe, effective alternative treatment for occlusive EIA disease. This study reports durable patency at five years and low perioperative morbidity and mortality.

Prostatic Artery Embolization in Occlusive Internal Iliac Artery Disease: The Long and Winding Road

An 83-year-old man with benign prostatic hyperplasia (prostate volume, 110 cm3) and primary complaint of recurrent gross hematuria was referred for prostatic artery embolization. He had cardiac comorbidities, including atrial fibrillation requiring anticoagulation. Prostatic artery embolization was thought to be a good option to reduce his hematuria while allowing anticoagulation to be continued. Computed tomography angiography demonstrated atherosclerosis and severe bilateral internal iliac artery disease.

External Iliac Artery Disease Adversely Affects Healing of Transtibial Amputations

External Iliac Artery Disease Adversely Affects Healing of Transtibial Amputations

Korean Multicenter Registry Study of EPIC Stents for the Treatment of Iliac Artery Disease: K-EPIC Registry.

Background and ObjectivesThe EPIC™ stent is a self-expanding, nitinol stent that has been designed to enhance flexibility and provide expansion within vessels. The aim of the present study was to investigate the clinical efficacy and safety of the EPIC™ stent when used to treat iliac artery diseases in a prospective Korean multicenter registry.MethodsA total of 138 patients with iliac artery diseases who received endovascular treatment with EPIC™ stents at 9 Korean sites were enrolled in a prospective cohort and followed for 1 year. The primary endpoint was the 1-year freedom from target lesion revascularization (TLR). The secondary endpoints were 1-year clinical patency and freedom from major adverse events (MAEs).ResultsThe mean age of the study subjects was 66.8±8.5 years and most subjects were male (86.2%). The most frequent lesion type was Trans-Atlantic Inter-Society Consensus B (43.5%) and the majority (56.5%) of the target lesions were located in the common iliac artery. Procedural success was obtained in 99.3% of patients. The freedom from TLR and the clinical patency at 1-year follow-up were 94.9% and 92.3%, respectively. The 1-year rate of MAEs was 5.1%. Combined coronary artery disease (hazard ratio [HR], 5.91; 95% confidence interval [CI], 1.13–30.89; p=0.035) and smaller stent diameter (HR, 0.38; 95% CI, 0.17–0.88; p=0.023) were identified as independent risk factors of TLR after EPIC™ stent implantation.ConclusionsThe EPIC™ stents demonstrated excellent immediate and 1-year efficacy and safety outcomes in iliac artery lesions in this multicenter, prospective, registry-based study.

Shockwave™ Lithoplasty in Combination With Atherectomy in Treating Severe Calcified Femoropopliteal and Iliac Artery Disease: A Single-Center Experience

BackgroundCalcium is a predictor of poor outcome in the treatment of infrainguinal arterial disease. Rotational atherectomy can effectively debulk atherosclerotic calcium but is less likely to significantly modify medial and adventitial calcinosis. Shockwave IVL provides circumferential sonic pressure waves capable of disrupting deeper calcium and theoretically complements the debulking process of atherectomy. We present acute and intermediate outcome data from patients with severe femoral or iliac artery calcified disease treated with the combination of rotational atherectomy and Shockwave IVL at a single center. MethodsThis is a retrospective study of prospectively collected data on rotational atherectomy (Jetstream (Boston Scientific) and orbital atherectomy (CSI)) from a single operator at a single center with core laboratory analysis of angiographic imaging. All patients that received the combination treatment of rotational atherectomy and Shockwave IVL were included in this study. Patient follow-up was done from medical records with data extracted by an experienced research coordinator. Primary safety endpoint was freedom from major adverse events including major dissection (NHLBI C or higher), perforation, distal embolization, or major amputation defined as amputation above the ankle. Primary effectiveness endpoint was procedural success (≤ 30% residual at end of procedure). 23/24 (95.8%) patients were treated with drug coated balloons (DCB) post combination therapy. Secondary endpoint on follow-up was target lesion revascularization (TLR). ResultsA total of 24 patients were included. Mean age was 70.7 ± 9.9 years. Lesions were in the femoropopliteal 79.1%, common femoral 12.5% and iliac 8.3% arteries. 87.0% were claudicants and 58.3% diabetics. Chronic total occlusion was 12.5%, severe calcium 100%, lesion length 84.5 ± 37.1 mm, baseline stenosis 57.1 ± 18.9% and baseline minimal luminal diameter (MLD) 2.2 ± 1.1 mm. Patients were treated with Jetstream (n = 19) or Orbital (n = 5) atherectomy. Embolic filter was used in 58.3% of cases. Post atherectomy stenosis was 36.4 ± 17.5%, post adjunctive IVL 21.1 + 15.7%, and final stenosis 13.0 ± 10.9%. Bailout stenting was 4.6% and primary stenting 13.6% (total stenting rate 18.2%). Final MLD was 4.7 ± 0.8 mm, resulting in an acute gain of 2.5 mm. No infrapopliteal embolization or amputation was noted. At a mean follow up of 591.4 ± 175.2 days, 2 patients died (unrelated to procedure or device). Target lesion revascularization (TLR) at 12 months occurred in 2 patients or 2/22 (9%). At 18-month of follow up TLR occurred in 7/22 (31%) patients. ConclusionThe combination of atherectomy and shockwave IVL followed by adjunctive DCB is safe and appears to be effective in treating severe calcified disease with acceptable TLR on long term follow-up in a population of severe femoropopliteal disease.

Definition of Proficiency Level by a Virtual Simulator as a First Step Toward a Curriculum on Fundamental Skills for Endovascular Aneurysm Repair (EVAR)

At present, there is no proficiency-based curriculum for endovascular treatment of aortic aneurysm repair (EVAR) using virtual reality (VR) surgical simulators, whereas such curricula are available for the treatment of iliac and/or superficial femoral artery disease. The purpose of this work was to compute proficiency, defined by a benchmark level determined by the performance of experts, using a commercial VR simulator as a first step of a curriculum on EVAR. Expert endovascular surgeons (with more than 150 EVAR cases as first operators) from 12 major Italian centers completed three cases of EVAR of increasing difficulty level 3 times each, using the Angio Mentor simulator (by Simbionix) and Gore devices. Proficiency level was based on performance of expert surgeons, as assessed by metrics from a VR simulator. The participating surgeons had a median of 20 years of experience and executed a median of 440 EVAR. For the 3 simulated cases, the following proficiency values were respectively obtained: total procedure time: 22 minutes 32 seconds, 23 minutes 05 seconds, and 20 minutes 32 seconds; total amount of contrast injected: 85.16 mL, 89.97 mL, and 98.01 mL total fluoroscopy time: 10 minutes 39 seconds, 12 minutes 22 seconds, and 10 minutes 17 seconds; time to contralateral gate cannulation: 5 minutes 51 seconds, 7 minutes 09 seconds, and 3 minutes 32 seconds. We computed proficiency levels for 3 simulated cases of EVAR using a VR simulator. Our next step is to determine whether surgical residents can reach this level. Translational research will then be required to assess the impact of such training on real patients.

Left Distal Radial Artery Access Site in Primary Percutaneous Coronary Intervention: Is It Safe?

Background:Left distal radial artery access site has emerged as a new technique for coronary angiography procedures.Aims:We aimed at assessing its applicability as an alternative way for primary percutaneous coronary interventions in ST-elevation myocardial infarction.Study Design:Retrospective observational cohort study.Methods:Left distal radial artery was used as an access site in 30 consecutive ST-elevation myocardial infarction patients for primary coronary intervention. It was used by experienced operators who were unaware of the study. All patients had a prominent pulse in their left forearm and distal radial artery. Each patient’s left arm was gently bent into his/her right groin with comfortable position of the hand. The operator/s stood at the right side of the patient where both could make the arterial puncture. Demographic features and complications were recorded during the hospital stay.Results:Mean age of patients was 58 years with a male gender predominance of 87%. Fifteen patients were diagnosed of Inferior elevation myocardial infarction, 14 patients of Anterior, and one of Lateral elevation myocardial infarction. The most common culprit artery was the left anterior descending coronary artery (14 patients). Six patients were in KILLIP class II on admission and only one with Anterior elevation myocardial infarction was in severe pulmonary edema (KILLIP III) during intervention. All the procedures were successfully contemplated with 6 French Judkins catheters. Brachial spasm occurred in one patient which was resolved with intra-arterial nitrate. Transfemoral approach was changed to left distal radial access in 4 patients due to severe bilateral iliac artery disease. Mean puncture time was 37.36 seconds. There was no radial occlusion, hematoma, hand neurologic deficit or bleeding. Patients were discharged on an average duration of 4.2 days.Conclusion:Left distal radial artery can be used as an alternative safe and feasible access site for successful primary coronary interventions provided that it is performed by experienced operators.

Dealing with complex external iliac artery disease

Interventional therapy has emerged as the preferred way to treat the majority of patients with iliac occlusive disease. As Henretta and colleagues1 have identified, however, the results of treating this problem with stenting of extensive external iliac disease are not as successful as treatment of common iliac disease, and the technique they have described may be a way to improve outcomes. Whereas the cause of this inferior patency may relate to the diameter of the external iliac artery or to an inability to achieve adequate expansion of stents, it is clear that increasingly surgeons are combining iliac intervention in this location with some form of outflow enhancement, whether it be common femoral endarterectomy alone or in conjunction with an infrainguinal intervention or bypass grafting.

Intravascular Lithotripsy for Treatment of Calcified, Stenotic Iliac Arteries: A Cohort Analysis From the Disrupt PAD III Study

PurposeThe presence of calcification in the iliac arteries is associated with decreased procedural success and increased complication risk during endovascular intervention. The objective of this study was to evaluate the safety and efficacy of peripheral intravascular lithotripsy (IVL) during endovascular treatment of iliac arterial peripheral artery disease (PAD). MethodsThe Disrupt PAD III Observational Study is a prospective, non-randomized, multi-center single-arm study to assess the ‘real-world’ safety and effectiveness of the Shockwave Peripheral IVL System for the treatment of de novo calcified lesions in the peripheral arteries, with a goal of treating 1500 patients. This is an analysis of consecutive patients enrolled for treatment of an iliac artery, a specified sub-group, with at least moderate calcification and a minimum length of 20 mm. ResultsBetween December 2017 and July 2019, 118 patients with a total of 200 lesions were enrolled across 20 sites. 101 patients were treated primarily for claudication or critical limb ischemia, while 17 patients were treated to optimize the iliac vasculature for large-bore access. All 118 patients had successful IVL catheter delivery. The average reference vessel diameter was 7.3 mm ± 1.9 mm, with an average diameter stenosis of 83.1% ± 13.4% and an average lesion length of 58.3 mm ± 57.6 mm. Severe calcification was present in 82.0% of overall cases. Stent placement was performed in 72.9% of the overall cases. As expected, the access group received less adjunctive therapies including stents (41.2%, p < 0.001). Angiographic complications were minimal with no flow-limiting dissections and a final mean residual stenosis of 12.0% ± 12.1% with no differences between the groups. ConclusionsAcute results with IVL in calcified iliac lesions suggest that it is a safe and effective option for calcified, stenotic iliac disease. IVL can be used successfully both for treatment of PAD symptoms and to optimize access for large-bore procedures.

Role of Endovascular Intervention in Iliac Artery Disease TASC C and D Classification

Abstract Background: For more than forty years, endarterectomy and bypass grafting have been the primary means of surgically revascularizing peripheral vessels threatened by atherosclerotic disease. However, with today's endovascular technology, stenosis and occlusions in nearly every circulatory system can he approached intraluminally with balloon dilatation and intravascular stents. Aim of Study: Was to evaluate the technical success rates, primary patency, limb salvage, patient survival and compli-cations for TASC C and D iliac lesions treated by endovascular procedure. Additionally, the influence of the access site and the clinical outcomes were analyzed. Patients and Methods: Between 2017 and 2019, data from 40 consecutive patients at Al-Zahraa University Hospital and Damanhor Teaching Hospital with 47 chronic iliac artery stenosis and/or occlusion who were treated with EVT were reviewed. Results: The procedure time was longer for TASC D lesions than for TASC C lesions (180.43±45.97 vs. 131.69± 37.49: p=0.001). There were two post-operative deaths in the TASC D lesion group, with the cause being one myocardial infarction and one post-operative hospital acquired pneumonia. The total perioperative complication rate was higher in the TASC D lesions than in TASC C lesions [four (10%) vs. zero; p=0.011]. Corresponding 2-year primary patency rates were 100% in TASC C lesions, 71.4% in TASC D lesions and for all cases were 87.5%. Conclusion: This study demonstrated that the outcomes of EVT for TASC C and D aorto-iliac lesions were acceptable, with better technical success in TASC C lesions than in TASC D lesions. Furthermore, the 2-year patency rate for both TASC C and TASC D lesions was acceptable, and brachial access was useful for complex anatomy.

3:54 PM Abstract No. 48 National trends in endovascular management of iliac arterial disease: insights from the Medicare population

3:54 PM Abstract No. 48 National trends in endovascular management of iliac arterial disease: insights from the Medicare population