Iliac Artery Stent Research Articles

Antegrade dissection of external iliac artery after failed attempt of common femoral artery chronic total occlusion angioplasty

Introduction. Endovascular treatment of chronic total occlusion (CTO) represents a true challenge even for experienced interventional radiologists. We are presenting a case of hidden antegrade dissection of the external iliac artery (EIA) after a failed attempt to recanalize CTO of the common femoral artery (CFA). Case outline. A 52-year-old male patient was admitted for multidetector computed tomography (CT) angiography. Left common iliac artery (CIA) stenting was performed, followed by ?crossover? attempt of recanalization of right CFA CTO that failed. The next day, left femoral superficial artery angioplasty was performed and after one month, angioplasty of the left popliteal and the bellow-knee arteries. A month later, the patient was readmitted for surgical reconstruction of the CFA. After desobstruction, excellent inflow was obtained and a Dacron graft was inserted. A few hours postoperatively, Fogarty catheter thrombectomy was performed. The next morning, pulsations were weakened again and CT angiography showed antegrade dissection of the EIA. Stenting of the EIA was performed with two stents and a favorable outcome was achieved. After a detailed analysis of the CT, hidden thrombosed antegrade dissection of the EIA was noted in the lateral view, which was not seen in the posterior/anterior view and was presented as fibrous plaque with mural thrombosis. Dissection occurred after failed attempt of CFA recanalization and was clinically silent until flow was established triggering opening of the false lumen and the release of thrombotic masses. Conclusion. In patients with failed angioplasty of CTO of the CFA and CT characteristics of fibrous plaque proximal to the site of attempted angioplasty, thrombosed antegrade dissection should be considered.

TP5.2.5 The utility of ‘kissing’ common iliac artery stents in the management of occlusive atherosclerotic arterial disease of the aortic bifurcation

Abstract Introduction A systematic review published in 2017 concluded that ‘kissing’ iliac stents to treat occlusive disease of the aortic bifurcation was associated with high technical procedural success and good medium-term patency. We have explored this in a regional vascular unit. Methods Retrospective review of patients managed with endovascular treatment of aorto-iliac segment (March 2015 to September 2020). The median follow-up was 2-years. Key outcome variables included the patency of the reconstruction and requirement for secondary intervention. Results There were 1,348 iliac endovascular procedures performed for occlusive atherosclerotic arterial disease of the aorto-iliac segment of which 56 were ‘kissing’ iliac stents. Intervention was performed for chronic limb threatening ischaemia in 29 cases. In 37 cases patients had unilateral symptoms only and in 41 cases patients had either TASC A or B lesions. Technical success was achieved in 55 cases and the median duration of admission was 1-day. At follow-up there was clinical patency in 54 cases, although there were 3 major extremity amputations performed (all on the index admission). Conclusion As with much of the work on ‘kissing’ iliac stents the number of patients is small and the group of patients variable in terms of medical co-morbidity, presenting clinical features and morphology of iliac disease. The procedure appears to have high technical success and can be achieved with little in the way of major morbidity. Medium term durability is good.

In Situ Revascularization with a Rifampicin-Soaked Prosthesis to Treat Bare Iliac Artery Stent Infection: A Case Report.

Bare stent infection is an extremely rare complication of endovascular treatment. In such cases, surgical resection of the infected bare stent and revascularization are recommended; however, the revascularization strategy remains controversial. We present a case of a 78-year-old man with an infected aneurysm caused by a bare iliac artery stent infection. We resected the infected aneurysm and performed in situ anatomic reconstruction using a rifampicin-soaked prosthesis with omental coverage. The patient had no reinfection at the 3-year follow-up. Therefore, this procedure may be a useful treatment for bare iliac artery stent infections.

The effect of the stented iliac lesions TASC-II C, D on the femoropopliteal bypass patency: Propensity score-matched observational study.

Concurrent stenting of complex iliac lesions during infrainguinal bypasses can increase the complexity of a case and impact outcomes. Our aim was to evaluate the effect of inflow stenting of TASC-II C, D iliac lesions on femoropopliteal bypass patency. A retrospective observational cohort study of patients who underwent femoropopliteal bypass with TASC-II C, D iliac artery stenting (hybrid group) or without inflow lesions (non-hybrid group) was conducted. After propensity score matching, 120 patients were included in the non-hybrid group and 60 patients in the hybrid one. The median follow-up was 432 (193; 1313) days in the hybrid group and 472 (196; 1376) days in the non-hybrid group (p = 0.94). No significant differences were found between the groups in 30-day morbidity and serious adverse events. At 3 years, primary and secondary bypass patency for the hybrid group and non-hybrid group were 62.2% versus 59.9% (p = 0.36) and 63.7% versus 64.3% (p = 0.077), respectively. The primary patency of the iliac stents in patients of the hybrid group was 95% at 3 years. The estimated hazard ratio for primary patency for hybrid versus non-hybrid was 0.77, with 90% CI: 0.50-1.21; the noninferiority upper bound being 1.31, which corresponds to a 10% additive noninferiority margin for probabilities. The 3 years of freedom from amputation in patients with chronic limb-threatening ischemia was 94.1% and 75.0% in the hybrid and non-hybrid groups, respectively (p = 0.09). The outcomes of the femoropopliteal bypass in hybrid surgery supplemented with stenting of TASC-II C, D iliac lesions was similar to femoropopliteal bypass with intact inflow arteries.

Early Detection of Post-Endarterectomy Complication by Point-of-Care Ultrasound

Endarterectomy is an effective intervention to remove the atheromatous plaque in the inner lining of the artery, aiming to revascularize the occluded/stenosed vessel in patients with peripheral arterial occlusive disease (PAOD). The most common wound-related complication is postoperative bleeding, followed by infection, hematoma, and seroma. However, hematoma complications with air surrounded have rarely been reported in clinical cases. Case presentation: A 90-year-old female patient visited our emergency department because of a rapidly growing hematoma with pulsatile bleeding over her right groin area. She had received bilateral percutaneous transluminal angioplasty with endarterectomy for PAOD one month prior. A point-of-care ultrasound revealed a large hypoechoic mass, with a dirty shadow on the right groin area. Computed tomography angiography showed a hematoma over her right femoral region, with free air surrounding the right femoral artery. Angiography revealed an irregular shaped lesion on the right femoral artery without contrast extravasation. The patient was diagnosed with right-femoral post-endarterectomy infection with infected hematoma, with the inclusion of air. She underwent urgent excision and repair of the right femoral artery infectious lesion, debridement of the infectious hematoma and stenting of the right external iliac artery, common femoral artery and superficial femoral artery.

Silent myocardial ischemia in patients with type 2 diabetes mellitus: a clinical case

Background. Type 2 diabetes mellitus (DM) is an important medical, social, and economic problem due to the high prevalence of the disease, which often leads to disability and significantly increases mortality in elderly people. One of the causes of coronary heart disease (CHD) in patients with type 2 DM is autonomic cardiovascular neuropathy, which is characterized by damage to the autonomic nervous system and manifests itself in a varying clinical picture, including silent myocardial ischemia (SMI). The prevalence of SMI among patients with type 2 DM is much higher than in people without it. The purpose was to study the clinical case of a patient with type 2 DM and CHD, raise awareness of the prevalence and influence of type 2 DM on CHD progression by focusing on diagnostic research and treatment strategies. Materials and methods. The clinical case of the detected silent ischemia in a patient with type 2 DM was analyzed. The complaints were as following: high blood pressure, moderate shortness of breath during walking, pain, and numbness of the lower extremities. Anamnesis: type 2 DM over 20 years; endovascular stenting of the right common iliac artery due to obliterating atherosclerosis of the arteries of the lower extremities; hypertension over 10 years; obesity. Based on this data, CHD was suspected. Results. The Holter monitoring revealed rare episodes of reversible ischemic repolarization. ECG demonstrated the deviation of the electrical axis to the left, hypertrophy of the left ventricular myocardium, diffuse violation of repolarization processes. Ultrasound of the heart found aortic atherosclerosis, left ventricular myocardial hypertrophy, a moderate decrease in myocardial contractility. Ultrasound of vessels of the lower extremities showed the signs of obliterating atherosclerosis with decompensation of peripheral blood flow. Coronary angiography demonstrated left coronary artery with critical subocclusions (90 %), right coronary artery with chronic occlusion in the middle segment (100 %). There was established the diagnosis: coronary heart disease (silent ischemia); diffuse stenotic atherosclerosis of the coronary artery (coronary angiography May 2019); arterial hypertension II stage, degree 2; HF II stage; II NYHA; type 2 diabetes mellitus, insulin-dependent, decompensated; obesity I stage; obliterating atherosclerosis of the arteries of the lower extremities (condition after endovascular stenting of the right common iliac artery on January 2018); chronic pancreatitis in remission, peptic ulcer of the duodenum (operated in 1981); chronic cholecystitis in remission. The treatment was prescribed: insulin therapy, nebivolol, eplerenone, candesartan, clopidogrel, rosuvastatin. Coronary artery bypass grafting is recommended. Conclusions. Thereby, timely diagnosis and adequate treatment can avoid complications of type 2 DM and improve quality and lifetime. With type 2 DM, CHD is often masked and remains undiagnosed, leading to complications and death, therefore more attention to such patients is needed.

Unilateral Common Iliac Artery Ostial Lesion Stenting versus Kissing Stenting

Background: Iliac arteries are common sites of occlusive atherosclerotic disease that is responsible for symptomatic arterial insufficiency of lower extremities and as atherosclerosis is a systemic disease, iliac diseases frequently have coexistent disease below the inguinal ligament. Objective: This study aimed to assess using unilateral Common iliac artery stent versus kissing stent as regard clinical and technical success in unilateral ostial common iliac artery lesions. Patients and Methods: From December 2018 to December 2020 in Al-Azhar University Hospital and Military Hospitals in Cairo, we assigned 20 patients with unilateral common iliac artery ostial lesion to undergo either unilateral stent or kissing stent; in two equal groups. Patients were followed up on clinical, technical success, and complications. Results: Regarding co-morbidities, 80% were smokers, 40% were diabetic, 40% had hypertension (HTN), and 40% had ischemic heart disease (IHD). Regarding complication, 15% had small groin hematoma, 1% had distal emboli, 5% had arterial dissection and 5% had contrast-induced nephropathy. Conclusion: No significant difference between unilateral and kissing technique regarding clinical, technical success, and complications. The unilateral stent is as safe and effective as kissing stents in the treatment of unilateral common iliac artery ostial lesions as regarding high technical, clinical success, and patient clinical improvement.

Midterm Outcomes after Primary Stenting in Treatment of Atherosclerotic Iliac Arteries

IntroductionThe purpose of this study was to report the midterm outcomes of primary stenting of iliac arteries with additional factors which affect the outcome and to compare the results between patients with simple and complex aorta iliac occlusive disease (AOID).Material and methodsFrom January 2015 and March 2018, the study consisted of 103 lesions in 93 patients with common iliac artery (CIA) and/or external iliac artery (EIA) lesions which accompanied with severe claudication or critical limb ischemia. Balloon-expandable stents (BMS), self-expandable stents (SES) and covered stents (CS) were used to treat the lesions.ResultsLesions of 93 patients that were in CIA and/or EIA and treated with ET were included to the study (n=103). Seventy-one (68.9%) lesions were classified as simple AIOD group (TASCII A-B) while 32(31.1%) were classified as complex AIOD (TASCII C-D) group. In 72.8% of the lesions only mild calcification was detected while 27.2% lesions had moderate or severe calcification. Mean stent diameter for CIA position was 8.26±0.8mm and for EIA position was 7.52±0.8mm. Mean lesion length in patients treated with BMS were 52.5±21.0mm while SES were 63.6±28.3(p=0.03). Technical success was achieved in 101(98.1%) lesions. Significant differences in primary (93% vs 63%) and secondary (98% vs 82%) patency rates at 24 months were found between patients in simple and complex AIOD group (p<0.001 p=0.001)ConclusionsConclusion: In our study, it was found that the primary stenting in patients who had AIOD had satisfactory results with high immediate success, low complication rates and acceptable midterm outcomes.

Treatment of May–Thurner Syndrome in a Patient with an Iliac Artery Stent

May–Thurner syndrome (MTS) is caused by compression of the left iliac vein by the right iliac artery, leading to clinical manifestations of outflow obstruction in the lower limb and deep vein thrombosis. There have been increasing reports of iatrogenic MTS caused by medical implants. The authors report the case of a 60-year-old man who developed MTS after stenting of the right common iliac artery. Due to the debilitating nature of the patient’s symptoms of venous congestion in the left leg, he proceeded with endovascular venoplasty and venous stent insertion with concurrent intra-arterial balloon angioplasty of the existing right common iliac artery stent. Technical success and primary patency of arterial and venous stents were achieved. The patient remained asymptomatic at 6 weeks and 3 months follow-up and arterial and venous stents were found to be patent on duplex ultrasound. Surgical management of MTS may include thrombolysis, thrombectomy, venoplasty and stenting of the left common iliac vein. Care must be taken to preserve existing medical implants during treatment of MTS. The authors demonstrate that concurrent angioplasty of the right common iliac artery during treatment of the vein is an effective method of preventing arterial stent disruption during surgical management of MTS.

The Effect of Hypogastric Artery Revascularization on Ischemic Colitis in Endovascular Aneurysm Repair

BackgroundThe objective of the study was to examine the effect of hypogastric revascularization maneuvers on the rate of postoperative ischemic colitis among patients undergoing endovascular aortoiliac aneurysm repair. MethodsUsing the 2011-2018 Endovascular Aneurysm Repair Procedure-Targeted American College of Surgeons National Surgical Quality Improvement Program Participant Use Files, we analyzed patients undergoing elective endovascular infrarenal aortoiliac aneurysm repairs. Using multivariable modeling techniques, a cohort of patients at high risk for postoperative ischemic colitis was identified. The outcomes of this group were then compared using Pearson's chi-square testing in accordance with whether or not they underwent hypogastric revascularization. ResultsOf 4753 patients undergoing endovascular aortoiliac aneurysm repair in the National Surgical Quality Improvement Program cohort, 1161 had concomitant hypogastric revascularization procedures. High-risk predictors of ischemic colitis included chronic obstructive pulmonary disease and concurrent renal artery or external iliac artery stenting. There was not a significant association between pelvic revascularization and postoperative ischemic colitis [1.0% with versus 0.5% without pelvic revascularization; adjusted odds ratio of ischemic colitis with revascularization 2.07 (0.96, 4.46); P = 0.06] after adjustment for patient- and procedure-related factors. In a subgroup analysis of patients with a distal aneurysm extent beyond the common iliac artery, the incidence of ischemic colitis was significantly lower in patients without pelvic revascularization (0.1% versus 1.6%, P = 0.004). ConclusionsOur analysis of patients undergoing elective endovascular repair of infrarenal aortoiliac aneurysmal disease did not find a reduced incidence of postoperative ischemic colitis in patients who received a concomitant pelvic revascularization procedure, suggesting instead that such procedural adjuncts may actually increase risk for this complication.

Endovascular management of unilateral common iliac artery ostial occlusive disease; bilateral kissing stents, unilateral stent with contralateral supporting balloon or unilateral stent with contralateral safety wire; comparative study

Aim To evaluate the safety, early, and short-term efficacy of kissing stents, unilateral common iliac artery (CIA) stent with contralateral supporting balloon, and unilateral CIA stent with contralateral safety wire in patients with symptomatic unilateral CIA ostial occlusive disease. Patients and methods This prospective study was carried out from April 2016 to November 2019 at 6 October Insurance Hospital, Cairo, and Sohag University Hospitals on 79 patients complaining of de novo unilateral CIA ostial occlusive disease, Rutherford category 3, 4, and 5, who were divided randomly into three groups to be treated endovascularly by bilateral kissing stent technique (group A), unilateral CIA stent in affected side associated with supporting balloon in the contralateral CIA (group B), or unilateral CIA stent in affected side associated with a safety wire in the contralateral CIA (group C). Patients were scheduled to be evaluated and followed up for 1 year. Results Technical success rate was 100, 87, and 67.9 in groups A, B, and C, respectively (P=0.006). One-year primary patency rate was 91.7, 90.9, and 87.5% in groups A, B, and C, respectively (P=0.998). A total of seven (9.3%) patients developed significant stenosis. Of the seven patients, and three continued medically, as they were claudicant; three cases were treated by drug-coated balloon angioplasty, and one patient by aortofemoral bypass. Plaque shift incidence was 4.3 and 14.3% in groups B and C, respectively (P=0.095). Distal embolization occurred in the contralateral side in 8.7 and 17.9% in groups B and C, respectively (P=0.083). Conclusion Kissing stent technique for treatment of unilateral ostial CIA occlusive disease achieves excellent technical success with minimal early and short-term procedure-related complications compared with unilateral stent with contralateral supporting balloon or unilateral stent with contralateral safety wire.

Hybrid-based iliofemoral endarterectomy for severe and complete iliofemoral occlusive disease

ObjectivePrimary endovascular approaches are now the dominant modality for the treatment of iliac occlusive disease. However, stenting of the external iliac artery is plagued with high in-stent restenosis rates. This hybrid approach with fluoroscopic, retrograde iliofemoral endarterectomy combined with stenting was previously demonstrated to be both a safe and effective alternative to bypass and primary stenting alone for TransAtlantic Inter-Society Consensus (TASC) II C and D lesions. In this study, early outcomes and hemodynamic improvements of this hybrid approach are evaluated with an expanded patient population. MethodsThis was a single-institution, retrospective review of all hybrid-based retrograde iliofemoral endarterectomies from the common femoral artery extending to the proximal external iliac artery from January 1, 2010, to November 15, 2017. Data were collected from the electronic medical record and analyzed using standard quantitative statistical techniques. All preprocedure and postprocedure imaging was independently reviewed by two vascular surgeons. Variables included patient demographics, degree of ischemia, and stent characteristics. The primary outcomes were mortality and freedom from amputation, with secondary outcomes including changes in the ankle-brachial index and toe pressure. ResultsThe procedure was performed on 63 limbs in 51 total patients. In 33 limbs, the indication was critical limb ischemia (tissue loss/gangrene = 17, rest pain = 16) and 30 for lifestyle-limiting claudication. The cohort consisted of 84% TASC D and 16% TASC C. External iliac stenting was required in 68% (modal diameter, 10 mm) and ipsilateral common iliac stenting was completed in 75% (modal diameter, 9 mm). The ankle-brachial index significantly improved from 0.42 ± 0.25 to 0.73 ± 0.27 (P < .001) as did toe pressure from 29 ± 27 mm Hg to 59 ± 34 mm Hg (P < .001). Thirteen limbs ultimately required an infrainguinal procedure. One patient experienced an intraoperative iliac perforation that resolved with stenting. One death occurred within 90 days. Ninety-five percent of patients remained free from amputation. ConclusionsExtensive hybrid-based, retrograde iliofemoral endarterectomy with stenting is a safe and efficacious approach to severe iliac arterial occlusive disease, with excellent early outcomes. This series promulgates the hypothesis that extensive endarterectomy with selective iliac stenting yields superior results to external iliac stenting alone. Given the superb hemodynamic improvements in a larger patient population, this hybrid-based, extensive iliofemoral endarterectomy should be recommended as a minimally invasive, first-line treatment for severe iliac occlusive disease.

A Novel Universal Endovascular Robot for Peripheral Arterial Stent-Assisted Angioplasty: Initial Experimental Results.

The bottleneck of the development of endovascular interventional robot is that it cannot fully adapt to commercialized endovascular devices, such as guidewires, catheters, and stents, and cannot complete the entire procedure of endovascular treatment, for instance, stent implantation. The purpose of this study is to evaluate whether the novel universal endovascular interventional robot can adapt to different commercialized endovascular devices and accomplish the entire procedure of endovascular treatment of peripheral vascular disease. The novel universal endovascular interventional robot consists of 2 components: a master surgeon console and a robotic platform with 4 manipulators. An adult pig was served as the experimental animal. Bilateral iliac artery stent implantation was performed on the pig by the endovascular interventional robot using commercialized guidewires, catheters, and stent delivery systems. The novel universal endovascular interventional robot can adapt to commercialized endovascular devices, and most interventional procedures, such as insertion, withdrawal, and rotating, can be done through remote control. By coordinating multiple manipulators, complex actions such as superselection, crossing action, or implantation of self-expanding bare stent can be realized. The entire procedure took about 50 minutes, and the total exposure time of the surgeon was less than 1 minute. Postoperative angiography showed that the position of the stent grafts was accurate. The procedure was stable without any stent or surgical-related complications. The novel universal endovascular interventional robot can realize peripheral arterial stent-assisted angioplasty with commercialized devices. Through the design improvement, the problem related to stent implantation is solved, and the remote operation is realized throughout the endovascular procedure.

Multivessel endovascular therapy for undiagnosed vascular type Ehlers-Danlos syndrome. Successful percutaneous transcatheter coil embolization of hepatic artery pseudoaneurysm with stenting of right renal and iliac arteries in emergency setting

Among Ehlers-Danlos syndromes, the vascular type is the most severe because of its vascular complications. Transcatheter embolization of medium-sized arteries has become the first-line therapy for life-threatening hemorrhage. Ongoing multiple lesions causing hemorrhagic or ischemic complications in the acute phase can challenge patient management. Multivessel endovascular treatment has never been reported. In this study, we report successful single-session treatment by coiling of a ruptured pseudoaneurysm of the hepatic artery with stenting of dissected right renal and iliac arteries in a 46-year-old female. Percutaneous transfemoral approach was gained and sealed with a plug-based closure device. Genetic disease was subsequently confirmed by molecular analysis.

The Surgical Treatment and Genomic Analysis of a Rare Case of Oligometastatic Renal Cell Carcinoma of the Prostate

An 80-year-old male presented to the emergency department after an episode of gross hematuria 4 hours prior. Review of systems at the emergency department was positive for dysuria and chronic obstructive urinary symptoms while negative for fevers, chills, or flank pain. Of note, his past medical history includes atrial fibrillation on rivaroxaban anticoagulation, left bundle branch block, coronary artery disease (status postdrug-eluting stent placement to the left circumflex artery in 2003 and drug-eluting stent placement to the left anterior descending artery in 2013), peripheral vascular disease (status post bilateral iliac artery stent placements in 2009), chronic obstructive pulmonary disease, hyperlipidemia, gout, nephrolithiasis, and left renal cell carcinoma (RCC) status post left hand-assisted laparoscopic radical nephrectomy in 2003.

Outcomes after Standalone Use of Gore Excluder Iliac Branch Endoprosthesis for Endovascular Repair of Isolated Iliac Artery Aneurysms

The aim of our study was to describe outcomes of stand-alone use (i.e., without concomitant implantation of an aortic stent graft) of the Gore Excluder iliac branch endoprosthesis (IBE) for elective endovascular repair of isolated iliac artery aneurysms. We evaluated all consecutive patients electively treated for isolated iliac artery aneurysms using standalone Gore Excluder IBE (January 2014-December 2018). Early (i.e., 30-day) endpoints were technical success, mortality, major adverse events (MAEs), and major access-site complications. Late endpoints were survival, freedom from aortic-related mortality (ARM), internal iliac artery (IIA) primary patency, IIA branch instability, graft-related adverse events (GRAEs), secondary interventions, endoleaks (ELs), aneurysm sac behavior, and new-onset buttock claudication (BC). A total of 11 consecutive patients (10 men; median age 75years) were included. The technical success rate was 100%. At 30days, mortality, MAEs, and major access-site complications were all 0%. Survival and freedom from ARM were 91% and 100%, respectively; only one nonaortic related death was recorded during follow-up. At a median follow-up of 14months, IIA primary patency, IIA branch instability, and GRAEs were 100%, 0%, and 0%, respectively. No instances of graft migration ≥10mm were detected. No graft-related secondary interventions were recorded, and 2 patients required a procedure-related secondary intervention 3months after the index procedure (1 common femoral artery endarterectomy and 1 external iliac artery stenting). Although new-onset type 1 or type 3 ELs were never noted, one patient developed a new-onset type 2 EL. Aneurysm sac regression ≥5mm was noted in 6 patients (55%), whereas in the remaining ones, the sac size was stable. No instances of new-onset BC were noted. Use of standalone Gore Excluder IBE for elective endovascular repair of isolated iliac artery aneurysms is a safe, feasible, and effective treatment option. These results may support use of the technique as an effective means of endovascular reconstruction in patients with suitable anatomy.

From the Aortic Bifurcation to the Groin: Long-term Outcomes of Covered Kissing Stent Placement in Combination with Iliofemoral Reconstruction for Extensive Iliofemoral Occlusive Disease

The aim of this study was to evaluate outcomes of extensive iliofemoral reconstruction combining both iliac covered kissing stents (ICKS) with stenting of the external iliac artery (SEIA) and/or surgical femoral endarterectomy (SFE). From November 2010 to November 2017, patients with extensive iliofemoral occlusive disease-classified as Trans-Atlantic Inter-Society Consensus class D-treated by ICKS in combination with SEIA and/or SFE were included. Patients received ICKS+SEIA, ICKS+SFE, or ICKS+SEIA+SFE. Demographics, procedure details, and postoperative outcomes were recorded. Primary end points were primary patency (PP), primary assisted patency (PAP), and secondary patency (SP). Long-term patency was assessed by annual clinical and ultrasonographic examination. Among 156 consecutive ICKS procedures performed during the study period, 59 patients were included (81% men; median age, 65years). In all, 32 patients (54%) underwent ICKS+SEIA, 17 (29%) patients underwent ICKS+SFE, and 10 (17%) patients underwent ICKS+SEIA+SFE. Operative indication was either disabling claudication (n=46, 78%) or critical limb-threatening ischemia (n=13, 22%). A total of 92 limbs were revascularized, including 121 covered balloon-expandable stents and 65 self-expanding nitinol stents, with 100% technical success. Thirty-day mortality was 3% (2/59) and 5 (8%) patients suffered from local complications, with no early reintervention. Long-term patency rates were as follows: at 2years, overall PP, PAP, and SP were 82%, 86%, and 96%, respectively; at 5years, overall PP, PAP, and SP were 73%, 79%, and 95%, respectively. After a mean follow-up of 34±29months, 25% (15/59) patients underwent late reinterventions for either de novo iliac or femoral stenosis (n=9), iliac occlusion (n=4), or external iliac in-stent restenosis (n=2). Treatment of extensive iliofemoral occlusive disease involving ICKS in combination with SEIA and/or SFE is safe and effective, providing satisfactory long-term secondary patency, at the price of a significant reintervention rate.

Final results from a postmarket registry of an iliac leg graft with a continuous, spiral nitinol stent

ObjectiveTo evaluate clinical outcomes from a postmarket registry of the Zenith Spiral-Z abdominal aortic aneurysm iliac leg graft with a continuous, spiral nitinol stent that was designed for improved conformability, kink, and migration resistance. MethodsThis prospective, multicenter registry was designed to evaluate physician-reported outcomes of the Spiral-Z leg graft in up to 600 patients who underwent endovascular repair of abdominal aortic or aortoiliac aneurysms at up to 30 investigative sites in the United States and Canada. Study outcomes were focused on iliac limb occlusion, limb-related reintervention, limb-related endoleak, component separation, and device integrity. Short-term data were collected during an interval of 1 to 6 months, with longer term data collected at 12 months. ResultsBetween March 2012 and March 2015, 599 patients (mean age 74 ± 8 years; 87% male; 26% with aortoiliac aneurysm) were treated, with Spiral-Z iliac leg grafts placed in 564 left iliac arteries and 559 right iliac arteries. The mean iliac inner diameters (both left and right) were 9 ± 3 mm; moderate/severe occlusive disease, calcification, and vessel tortuosity were present in 14%, 25%, and 36% and 15%, 25%, and 34% of the left and right iliac arteries, respectively. Iliac artery adjunctive procedures (iliac artery angioplasty and/or stent placement) were performed intraoperatively in 112 patients (19%; bilateral in 52 patients). Mortality within 30 days was 1.7% (10/599); cumulative mortality at 1 year was 6.2% (37/599). There were no aortic ruptures and only one open conversion (0.2%). Limb occlusions occurred in 11 of 599 patients (2%; 3 within 30 days and 8 after 30 days, all unilateral, none had received procedural iliac artery adjuncts at implantation); of these, 7 patients underwent reinterventions. Other limb-related reinterventions were performed on eight patients for nonocclusive kink, compression, or thrombus (six within 30 days and three after 30 days). In total, 13 patients (2%) underwent 15 limb-related reinterventions (7 for occlusions and 8 for nonocclusive causes). In one patient, a distal type I endoleak and device migration (>10 mm) involving a right iliac leg was noted at the 12-month follow-up visit. No other limb-related endoleak, migration, component separation, or stent fracture was reported during a mean follow-up of 11 ± 6 months. ConclusionsThe Spiral-Z leg graft demonstrated excellent patency and required infrequent limb-related reinterventions in routine clinical care in a postmarket registry.

The association of preprocedural C-reactive protein/albumin ratio with in-stent restenosis in patients undergoing iliac artery stenting.

Introduction: In-stent restenosis (ISR) still constitutes a major problem after percutaneous vascular interventions and the inflammation has a pivotal role in the pathogenesis of such event. The C-reactive protein/albumin ratio (CAR) is a newly identified inflammatory biomarker, and it may be used as an indicator to predict ISR in subjects with coronary artery stenting. In light of these data, our main objective was to investigate the relationship between the preprocedural CAR and ISR in patients undergoing successful iliac artery stent implantation. Methods: In total, 138 consecutive patients who had successful iliac artery stent implantation in a tertiary heart center between 2015 and 2018 were enrolled in the study. The study population was categorized into two groups; patients with ISR and those without ISR during follow-up. The CAR was determined by dividing CRP by serum albumin. Results: In the multivariable regression analysis; the CAR (HR: 2.66, 95% CI: 1.66-4.25, P < 0.01), stent length (HR: 1.01, 95% CI: 0.99-1.02, P = 0.04), and HbA1c levels (HR: 1.22, 95% CI: 0.99-1.51, P = 0.04) were independently related with ISR. A receiver operating curve analysis displayed that the CAR value of >0.29 predicted ISR with sensitivity of 97.5% and specificity of 88.8% (AUC 0.94, P < 0.01). Conclusion: Our findings provide evidence that the CAR may be an applicable inflammatory biomarker in predicting ISR in subjects undergoing iliac artery stenting for the treatment of peripheral artery disease (PAD). Also, the stent length and poor glycemic control were found to be associated with ISR.

Retroperitoneal Aortobifemoral Bypass by a Combination of Horseshoe Kidney and Aortoiliac Occlusive Disease with Stent Thrombosis.

Bilateral aorto-profunda femoris bypass with Dacron bifurcation graft was performed by a patient with aortoiliac occlusive disease (AIOD) and horseshoe kidney (HSK) who had undergone stenting of the right common iliac artery and of the left superficial femoral artery with subsequent stent thrombosis as well as significant subrenal aortic stenosis. As endovascular treatment was not feasible and surgical treatment by means of transperitoneal incision would be associated with high risk of damage to the HSK, the operation was successfully accomplished through left pararectal retroperitoneal approach.