Iliac Artery Stent Research Articles

En bloc tibial thrombectomy

A 58-year-old man with hypertension and 40-pack year smoking history presented to the emergency department complaining of approximately 20 hours of right lower extremity pain. His initial symptom was shortdistance claudication, but quickly progressed to rest pain. Physical examination demonstrated right lower extremity pallor, delayed capillary refill, diminished sensation and strength, with absent femoral, popliteal, dorsalis pedis, and posterior tibial pulses. A pelvic and lower extremity computed tomography angiogram (CTA) revealed occlusion of the right common iliac artery with reconstitution at the level of the right common femoral artery from inferior epigastric artery, total occlusion of the popliteal artery, and no reconstitution distally. After heparinization, he emergently underwent iliac thromboembolectomy. Intraoperative angiography revealed residual thrombus in the proximal right common iliac artery which was treated with the placement of covered stents in the bilateral common iliac arteries. The below-knee popliteal artery was then exposed to address the occlusion seen on preoperative CTA (A). Using a Fogarty embolectomy catheter (Edwards Lifesciences, Irvine, Calif) and a DeBakey forceps through a transverse popliteal artery incision, one contiguous thrombus was removed en bloc, revealing a cast of the tibial trifurcation (B). The vessel was closed primarily and a palpable dorsalis pedis pulse was established. Given the duration of ischemia, a fourcompartment fasciotomy was performed. Postoperative workup demonstrated the source to most likely be a large mural thrombus in the visceral aorta (C). He is currently anticoagulated with warfarin. At 6-month follow-up, he reported ambulating near baseline, and had a palpable dorsalis pedis pulse with an ankle-brachial index of 1.1. Additionally, duplex imaging revealed widely patent vessels and follow-up CTA demonstrated near complete resolution of the aortic thrombus (D).

An Analysis of the Factors Influencing Radiation Dose and Fluoroscopic Time During Renal Artery Stent Placement

To determine the factors that affect mean absorbed dose and fluoroscopic times during renal artery stent placement. After institutional review board approval, the HI-IQ database was queried for patients undergoing renal artery stent placement only from January 2007 to June 2010. Procedures that were performed as part of other procedures such as iliac artery stents were excluded. The HI-IQ data included fluoroscopy time (f) and radiation dose (mGy). Demographic, medical history, procedural details, and advanced preprocedural renal artery stent imaging were obtained. Variables (number of stents, average body mass index , number of stents placed per year and number of years' service of an interventional physician, pre-procedural imaging, and use of embolic protection device) were analyzed using a t test after log transformation and testing for variance with an F test. A total of 134 patients (75 males, 70.6 ± 10.5 years old) underwent the placement of 177 renal artery stents (unilateral [n = 95], average stent per patient = 1.3). Mean fluoroscopy time was 15.6 minutes and mean absorbed dose to the patient was 1729 mGy. The average fluoroscopic time and absorbed dose was significantly higher with bilateral stent placement compared to unilateral placement (13.8 vs 19.7 minutes, P = .002; 1803 vs 2380 mGy, P = .03). The average fluoroscopic time was significantly higher in patients undergoing abdominal aortogram prior to renal artery selection and stent placement. The placement of more than 1 stent with an abdominal angiogram prior to renal artery stent placement results in increased fluoroscopic time and mean absorbed dose.

Effect of procedure volume on outcomes after iliac artery angioplasty and stenting

Service reorganization to concentrate complex vascular services in hospitals with high caseload volume aims to reduce mortality and complication rates. The present study assessed the relationship between caseload volume and outcome for iliac artery angioplasty and stenting in England using a routinely available national data set (Hospital Episode Statistics, HES). Routine administrative data for iliac artery angioplasty and stent procedures performed in England between 2007 and 2011 were analysed. Associations between centre volume and outcomes (death, complications and duration of hospital stay) were tested and compared for two methods of stratification (quartiles and quintiles) and two statistical tests (odds ratios and the Cochran-Armitage test for trend). Multivariable analysis was also performed. There were 23,308 episodes of care recorded in HES with Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures, fourth revision, codes L54.1 or L54.4 corresponding to iliac artery intervention. There was a gradual increase year by year in number of procedures performed. Univariable and multivariable analysis showed no association between centre volume and either death or complications (multivariable odds ratio, OR 1.00, 95 per cent confidence interval 1.00 to 1.00) for elective and non-elective procedures. Age was associated with higher mortality and complication rates in elective procedures, and with mortality in non-elective procedures. The risk of death after elective iliac angioplasty or stenting was significantly higher in women (multivariable OR 4.98, 2.09 to 13.26). There was no association between the outcomes of endovascular iliac artery intervention and centre volume, but outcomes were significantly worse with increasing age and female sex.

Endovascular reconstruction of iliac artery bifurcation atherosclerotic disease with the kissing technique

A 71-year-old male patient with severe left buttock and lower-extremity claudication due to iliac artery bifurcation stenoses was referred to our institution for endovascular treatment. A 'kissing' technique was used in order to dilate the proximal parts of both internal and external iliac arteries and avoid compromization of the internal iliac artery during proximal external iliac artery stenting. A balloon expandable stent was inserted via a left ipsilateral retrograde access to the narrowed origin of the left external iliacartery and a balloon catheter via a right contralateral access inside the origin of the left internal iliac artery. Simultaneous balloons inflation restored full patency of both vessels. Twelve months later the patient is doing well, free of buttock or lower-extremity claudication symptoms. For iliac artery bifurcation atherosclerotic disease, endovascular repair with the 'kissing' technique can achieve a complete bifurcation reconstruction offering significant clinical benefit in selected patients.

Atherosclerosis: A systemic disease

1878-7649/$ – see front matter 2013 Elsevier Masson SAS and European Union Ger http://dx.doi.org/10.1016/j.eurger.2013.02.006 stenting of the external iliac artery, and 7 years earlier, a right mid femoro-popliteal bypass with endarterectomy of the femoral crux, for peripheral artery disease (Fontaine stage III) (Fig. 1a). She had been diagnosed with stenosis of the left subclavian artery in the presence of asymmetrical blood pressure (Fig. 1b), but had never been assessed for myocardial ischemia. She was admitted for unstable angina. The electrocardiogram showed diffuse ST depression and a ST elevation in aVr and V1 leads (Fig. 2) and Troponin I was positive (4 ug/L, N < 0.009 ug/L). The emergent coronary angiogram showed severe three vessels coronary artery disease with sub occlusion of the left main stem (Fig. 3a) and mid right coronary artery (RCA) (Fig. 3b). Because of the anatomy of the coronary artery lesions and concomitant diabetes, the heart team opted for surgical revascularization. In the preoperative assessment, injection of the carotid arteries (Fig. 1c) and of the ascending aorta showed important atherosclerosis and severe stenosis of the left subclavian artery (Fig. 1b). After treatment by a triple saphenous vein bypass graft, postoperative course was uneventful.

Unilateral Iliac Artery Stenting Improves Perfusion and Symptoms in Both Limbs in Patients With Bilateral Iliac Lesions

To test the hypothesis that unilateral dilation of a common (CIA) or internal iliac artery (IIA) stenosis in selected patients with contralateral chronic iliac artery occlusion is adequate to offer clinical benefit to the untreated chronically occluded limb. Sixteen patients (11 men; mean age 66.7±4.9 years) with chronic occlusion of one CIA [with or without extension to the external iliac artery (EIA)] and CIA stenosis (n=11), IIA stenosis (n=3), CIA and IIA stenoses (n=1), or IIA and EIA stenoses (n=1) on the contralateral side were treated with unilateral angioplasty/stenting of the iliac artery stenosis as sole treatment for both limbs. Clinical and hemodynamic success of this approach was assessed for both limbs. Eleven patients were treated with stenting of the stenosed CIA, 2 with IIA dilation, one with IIA stenting, one with stenting of both the CIA and IIA, and the last with IIA and EIA stenting. Technical success was obtained in all. Immediate hemodynamic success was also 100% for both limbs: the mean resting ankle-brachial index increased from 0.67±0.06 to 0.88 ± 0.04 on the stenosis side and from to 0.53±0.06 to 0.69±0.07 in the contralateral occluded limb (p<0.001). Clinical success was 100% for the treated limb immediately after the procedure and 93.8% for the contralateral limb. One patient with ischemic rest pain in the occluded limb continued to experience severe symptoms after contralateral CIA stenting despite hemodynamic improvement; he had a femorofemoral graft implanted 2 months after the initial intervention and was considered the only clinical failure. During a mean 24-month follow-up (range 12-54), all stented arteries remained patent. In selected patients with CIA or IIA stenosis and long chronic occlusion of the contralateral iliac axis, unilateral dilation/stenting of the stenosis alone increases blood flow and improves clinical symptoms to both limbs.

Acute Occlusion of a Femoro-Popliteal Bypass Graft after Primary Cementless Total Hip Arthroplasty

Vascular complications after total hip arthroplasty (THA) are rare and mainly occur after revision surgery, and of these complications, large artery thrombosis is relatively uncommon. Nevertheless, this complication has potentially devastating effects on the affected lower extremity. The authors report a case of acute thrombosis in an iliac artery stent and femoro-popliteal bypass graft after primary cementless THA, and include relevant literature review.

Therapeutic Effects of Water Soluble Danshen Extracts on Atherosclerosis

Danshen is a traditional Chinese medicine with many beneficial effects on cardiovascular diseases. The aim of this study was to evaluate the mechanisms responsible for the antiatherogenic effect of water soluble Danshen extracts (DEs). Rat vascular smooth muscle cells (VSMCs) and human umbilical vein endothelial cells (HUVECs) were treated with DE. To evaluate the effects of DE in vivo, carotid balloon injury and tail vein thrombosis were induced in Sprague-Dawley (SD) rats and iliac artery stent was induced in New Zealand white rabbits. The inhibitory action of DE on platelet aggregation was confirmed with an impedance aggregometer. DE inhibited the production of reactive oxygen species, and the migration and proliferation of platelet-derived growth factor-BB stimulated VSMCs. Furthermore, DE prevented inflammation and apoptosis in HUVECs. Both effects of DE were reconfirmed in both rat models. DE treatment attenuated platelet aggregation in both in vivo and ex vivo conditions. Pretreatment with DE prevented tail vein thrombosis, which is normally induced by κ-carrageenan injection. Lastly, DE-treated rabbits showed decreased in-stent restenosis of stented iliac arteries. These results suggest that water soluble DE modulates key atherogenic events in VSMCs, endothelial cells, and platelets in both in vitro and in vivo conditions.

Preclinical Evaluation of Coronary Stents: Focus on Safety Issues

In recent years, we have witnessed a revolution in the treatment of coronary artery disease. The development and improvement of drug eluting stents (DES) have lowered the incidence of restenosis to one-digit figures. In the search for a superior efficacy, animal models have played a key role. The classical swine model of coronary stenting remains the preferred model to measure restenosis, although the rabbit iliac artery stenting has become an accepted alternative. After widespread clinical use of DES, an unforeseen complication arose: late stent thrombosis. In a back-to-bench step, some data from animal models helped to explain the phenomenon. A delayed and incomplete vascular healing was detected. Toxic and hypersensitivity reactions to polymers and/or drugs seem to be the underlying causes. So, translational research focused on the safety aspect of these devices: development of better drug carriers as absorbable polymers or fully bioresorbable scaffolds, selection of different drugs and assessment of the re-endothelialization process. We review and evaluate the efficacy and safety of coronary stents in different animal models. Further improvements in this field such as, the selection of better animal models (e.g. hyperlipidemic, diabetic, atherosclerotic) that closely mimic the clinical setting and longer follow-up periods to detect late complications are also discussed.

Preclinical Evaluation of Coronary Stents: Focus on Safety Issues

In recent years, we have witnessed a revolution in the treatment of coronary artery disease. The development and improvement of drug eluting stents (DES) have lowered the incidence of restenosis to one-digit figures. In the search for a superior efficacy, animal models have played a key role. The classical swine model of coronary stenting remains the preferred model to measure restenosis, although the rabbit iliac artery stenting has become an accepted alternative. After widespread clinical use of DES, an unforeseen complication arose: late stent thrombosis. In a back-to-bench step, some data from animal models helped to explain the phenomenon. A delayed and incomplete vascular healing was detected. Toxic and hypersensitivity reactions to polymers and/or drugs seem to be the underlying causes. So, translational research focused on the safety aspect of these devices: development of better drug carriers as absorbable polymers or fully bioresorbable scaffolds, selection of different drugs and assessment of the re-endothelialization process. We review and evaluate the efficacy and safety of coronary stents in different animal models. Further improvements in this field such as, the selection of better animal models (e.g. hyperlipidemic, diabetic, atherosclerotic) that closely mimic the clinical setting and longer follow-up periods to detect late complications are also discussed. Keywords: Animal model, drug eluting stent, endothelium, inflammation, percutaneous coronary intervention, safety, stent thrombosis vascular healing

Preclinical Evaluation of Coronary Stents: Focus on Safety Issues

In recent years, we have witnessed a revolution in the treatment of coronary artery disease. The development and improvement of drug eluting stents (DES) have lowered the incidence of restenosis to one-digit figures. In the search for a superior efficacy, animal models have played a key role. The classical swine model of coronary stenting remains the preferred model to measure restenosis, although the rabbit iliac artery stenting has become an accepted alternative. After widespread clinical use of DES, an unforeseen complication arose: late stent thrombosis. In a back-to-bench step, some data from animal models helped to explain the phenomenon. A delayed and incomplete vascular healing was detected. Toxic and hypersensitivity reactions to polymers and/or drugs seem to be the underlying causes. So, translational research focused on the safety aspect of these devices: development of better drug carriers as absorbable polymers or fully bioresorbable scaffolds, selection of different drugs and assessment of the re-endothelialization process. We review and evaluate the efficacy and safety of coronary stents in different animal models. Further improvements in this field such as, the selection of better animal models (e.g. hyperlipidemic, diabetic, atherosclerotic) that closely mimic the clinical setting and longer follow-up periods to detect late complications are also discussed. Keywords: Animal model, drug eluting stent, endothelium, inflammation, percutaneous coronary intervention, safety, stent thrombosis vascular healing

Characterization and in vivo evaluation of a bio-corrodible nitrided iron stent

A bio-corrodible nitrided iron stent was developed using a vacuum plasma nitriding technique. In the nitrided iron stents, the tensile strength, radial strength, stiffness and in vitro electrochemical corrosion rate were significantly increased compared with those of the control pure iron stent. To evaluate its performance in vivo, the deployment of the nitrided iron stents in juvenile pig iliac arteries was performed. At 3 or 6 months postoperatively, the stented vessels remained patent well; however, slight luminal loss resulting from intimal hyperplasia and relative stenosis of the stented vessel segment with piglets growth were observed by 12 months; no thrombosis or local tissue necrosis was found. At 1 month postoperatively, a nearly intact layer of endothelial cells formed on the stented vessel wall. Additionally, a decreased inflammation scoring, considerably corroded struts and corrosion products accumulation were seen. These findings indicate the potential of this nitrided iron stent as an attractive biodegradable stent.

Results of iliac stenting and aortofemoral grafting for iliac artery occlusions

To compare long-term results of percutaneous iliac artery stenting (PCIS) with aortobifemoral (ABF) grafting for patients with symptomatic iliac artery occlusions. A retrospective review of 229 patients (January 2000 to December 2011) with symptomatic iliac artery occlusions was performed. In 100 patients, 103 PCIS procedures were performed, and 101 patients underwent ABF grafting. Outcome data including periprocedural complications, improvement in ankle-brachial index, morbidity, and mortality were collected in a vascular registry. Kaplan-Meier estimates for patency and survival were analyzed. Univariate (Fisher exact test) and multivariate analyses of variables associated with the loss of primary patency were performed. Patients in the ABF grafting group were younger (60 ± 0.9 years old vs 65 ± 1.2 years old; P = .002) and more commonly had a history of nicotine abuse (97% vs 86%; P = .002), chronic obstructive pulmonary disease (85% vs 70%; P = .02), and a greater incidence of superficial femoral artery disease (45% vs 24%; P = .001). The most common presenting symptoms in both groups consisted of intermittent claudication (66% ABF vs 71% PCIS), rest pain (20% ABF vs 17% PCIS), and ulceration or gangrene of toes (14% ABF vs 15% PCIS). At 72 months, the primary patency for ABF bypass was greater than for PCIS (91% vs 73%; P = .010). Secondary patency rates were equivalent in both groups (98% ABF vs 85% PCIS). Survival in the ABF bypass group was significantly greater than in the PCIS group (76% vs 68%; P = .013). Hyperlipidemia (hazard ratio, 2.55; P = .049) and concurrent superficial femoral artery lesion (hazard ratio, 2.61; P = .026) were factors associated with the loss of primary patency for the entire cohort. The average hospital stay was 7 ± 2 days in the ABF group and 1 ± 0.3 days in the PCIS group (P = .0001). There were no periprocedural deaths in the PCIS group; there were four deaths in the ABF group (P = .058). In the PCIS group, ankle-brachial index increased from 0.66 to 0.89, and in the ABF group, ankle-brachial index increased from 0.54 to 0.98 (both groups, P < .001). This study demonstrates that PCIS remains a suitable, less invasive first-line therapy for iliac artery occlusions. PCIS has lower morbidity, shorter hospital length of stay, and equivalent secondary patency but inferior primary patency compared with ABF.

Abstract 9971: Comparison of Stents Coated with Antibody against CD34 versus Vascular Endothelial-Cadherin: Anti-VE-Cadherin-Antibody-Coated Stents are Better In Rapid Endothelialization and Reduction of Neointimal Formation

Background Vascular endothelial-cadherin is exclusively expressed on the late endothelial progenitor cells. We evaluated whether anti-VE-cadherin antibody-coated stents might accelerate endothelial recovery and reduce neointimal formation more than anti-CD34 antibody-coated stents through the superior ability to capture the late EPC. Methods The BMS were coated with anti-VE-cadherin antibodies or anti-CD34 antibodies under the same condition. In vitro, the ability to capture EPC and specific cell capturing ability was evaluated. In vivo, re-endothelialization of stent in the rabbit iliac arteries was assessed by serial scanning electron microscopy. At 42 days, the area and proliferating activity of the neointima was compared between two stents. Results VE-cad stents showed higher number of adhering EPC (823.6 ± 182.2 versus 379.2 ± 137.2 cells/HPF, p&lt;0.001). VE-cad stents also demonstrated better specific capturing of cells with endothelial lineage markers than CD34 stents did in flow cytometric analysis. VE-cad stents showed more effective re-endothelialization after 3 days in vivo. At 42 days, VE-cad stents demonstrated significantly smaller neointima area (0.92 ± 0.38 versus 1.24 ± 0.41 mm 2 , p=0.002) and significantly lower PCNA positive cells in neointima (1684.8 ± 658.8/mm 2 versus 2681.7 ± 375.1/mm 2 , p=0.008), compared with CD34 stents. Conclusions VE-cad stents captured EPC and endothelial cells more selectively in vitro, accelerated re-endothelialization over stents, and reduced neointimal formation in vivo, compared with CD34 stents. Targeting the VE-cadherin could be more reasonable strategy in developing the next generation pro-healing stents.

Transient paralysis from carbon dioxide angiography in a patient after four-vessel endovascular thoracoabdominal aortic aneurysm repair

Contrast angiography with carbon dioxide (CO2) is frequently used in patients with renal dysfunction or iodinated contrast allergies, as CO2 is nonallergenic, nontoxic, and rapidly absorbed in the blood. However, when delivered intra-arterially, there is a possibility that CO2 may create a vapor lock with resultant transient ischemia. We describe a case of suspected CO2 embolus to the iliolumbar artery after iliac artery stenting resulting in immediate loss of bilateral lower extremity motor and sensory function. After placement of a spinal drain and elevation of mean arterial blood pressure, the patient had complete return of sensation with improvement in motor function.

Resolute® and xience V® polymer‐based drug‐eluting stents compared in an atherosclerotic rabbit double injury model

To evaluate differences in strut coverage, inflammation and endothelialization between two second-generation polymer-based drug-eluting stents (DES) in an atherosclerotic rabbit double-injury iliac artery model at 28 days follow-up. Rabbits with induced atheroma received bilateral iliac artery stents: everolimus-eluting stent (Xience V EES; Abbott Vascular), zotarolimus-eluting stent (Resolute ZES; Medtronic CardioVascular), or bare-metal stent (BMS; MultiLink Vision; Abbott Vascular). After 28 days, total neointimal coverage examined by scanning electron microscopy was >98% for all three stent types. Neointimal thickness above stent struts was decreased by 50% in Xience V EES (0.06 ± 0.01 mm; P = 0.00001) compared with BMS (0.15 ± 0.03 mm) and Resolute ZES (0.12 ± 0.04 mm). Luminal area was largest for Xience V EES (3.79 ± 0.33 mm(2) ; P = 0.0003 for Xience V EES vs. BMS), followed by Resolute ZES (3.46 ± 0.45 mm(2) ; P = 0.083 for Resolute ZES vs. BMS) and BMS (3.07 ± 0.53 mm(2) ). Percentage area stenosis was smallest for Xience V EES (17.23 ± 3.64%; P = 0.00001), while BMS (30.25 ± 7.48%) and Resolute ZES (30.79 ± 7.15%) did not differ. Endothelial monolayer regrowth was significantly lower in Resolute ZES (65 ± 13%) versus BMS (79 ± 11%; P = 0.004). There was no difference between Xience V EES (74 ± 10%) and BMS. Xience V EES was further associated with a lower number of inflammatory cells surrounding the stent struts (7 ± 2 per strut) in comparison to Resolute ZES (15 ± 6; P = 0.0001) and BMS (17 ± 9; P = 0.0005). In this atherosclerotic rabbit model, Xience V EES suppressed neointimal thickening better, with normal endothelial regrowth as compared with BMS, and less strut-induced inflammation.

Vasomotor function and re-endothelialisation after implantation of biodegradable abluminal polymer coated paclitaxel-eluting stents in rabbit iliac arteries: a time-course study

To evaluate the time-course of vasomotor function and re-endothelialisation after implantation of a novel platinum-chromium (PtCr) abluminal biodegradable polymer-coated paclitaxel-eluting stent (PES, Labcoat Element) in rabbit iliac arteries. Either PES (n=18) or an identical platform of bare metal stents (BMS, Element, n=18) were implanted in rabbit iliac arteries (six animals per time-point). At 14, 30, and 90 days, acetylcholine- and nitroglycerine-induced vasomotor reactivity at 5-10 mm distal to the stent was measured. Subsequently, the animals were terminated. The stented artery was bisected longitudinally for either SEM or en face CD31 immunochemistry examination. All arteries were patent with normal angiographic flow. Decreased endothelial-dependent vasomotion was found at both 14 and 30 days for PES compared to BMS (p<0.01, respectively); however, these differences resolved by 90 days. Endothelial-independent vasorelaxation was similar at all three time-points. Both SEM and en face staining demonstrated equivalent endothelial coverage on the surface of the stented segments above and between struts at all time-points. This novel bioabsorbable polymer abluminal-coated PES demonstrated vasomotor function comparable to BMS within three months post-deployment in the rabbit iliac model. Despite indistinguishable endothelial cell coverage on the stent surface between groups, earlier differences in vasomotion were detected: this finding suggests that the timing of restoration vasomotor function lags morphologic endothelial recovery.

Iliac Artery Stent Placement Relieves Claudication in Patients with Iliac and Superficial Femoral Artery Lesions

To evaluate the efficacy of iliac artery stent placement for relief of claudication in patients with both iliac and superficial femoral artery (SFA) lesions. Stent placement for only iliac artery occlusive disease was performed in 94 limbs (74 patients) with both iliac and SFA occlusive disease on the same limb. All procedures were performed because intermittent claudication did not improve after continuation of antiplatelet medication therapy and home-based exercise for 3 months. Rutherford classification was 2 in 20 limbs and 3 in 74 limbs. Patients with critical limb ischemia were excluded. Median duration of follow-up was 40 months. Primary patency rates of the iliac stent, clinical improvement rates, and risk factors for requiring additional SFA procedures were evaluated. Primary patency rates of the iliac stent at 1, 3, 5, and 7 years were 97, 93, 79, and 79 %, respectively. The initial clinical improvement rate was 87 %. Continued clinical improvement rates at 1, 3, 5, and 7 years were 87, 81, 69, and 66 %, respectively. SFA Trans-Atlantic Inter-Society Consensus (TASC) II C/D lesion was a significant risk factor for requiring additional SFA procedures. Intermittent claudication was relieved by iliac stent placement in most patients with both iliac and SFA lesions. Thus, the indications for treatment of the SFA intended for claudicants should be evaluated after treatment of the iliac lesion.

External Iliac Artery Stenting

To review immediate results, patency rates, hemodynamic success, and incidence of concomitant procedures with external iliac artery stenting (EIAS). Demographic features, category and clinical grade, Trans-Atlantic Inter-Society Consensus II classification lesion type, pre- and postprocedure ankle-brachial indices, and primary patency were compared between group 1 (EIAS without distal revascularization) and group 2 (EIAS with concomitant distal revascularization). No mortality and a 100% immediate technical success rate was recorded in group 1 (n = 12) and group 2 (n = 24). Eleven patients (30.6%) also had stenting of the adjacent common iliac artery. Two thirds of group 2 patients required concomitant femoral or distal revascularization. No difference in stent patency rates was found between patients in group 1 versus group 2. Patients requiring EIAS tend to have more diffuse arterial disease necessitating complicated open reconstruction and/or distal revascularization, as well as more proximal iliac stenting.

Balloon-expandable stent deformation during deployment into the iliac artery: a procedural complication managed conservatively

The management of aortoiliac insufficiency has been improved considerably since the introduction of balloon-expandable stents in 1991. Although numerous studies have shown the safety and efficacy of balloon-expandable iliac artery stent placement, the procedure is not without potential complication. We report here a very unusual case of iliac artery stenting being complicated by deformation and elongation of the stent following balloon rupture at initial deployment with retention of the distal balloon marker and our successful approach to subsequent management with combined acetylsalicylic acid and clopidogrel. In conclusion, this conservative approach may be an alternative treatment of a partially deployed aortoiliac stent with a retained foreign body when further intervention is considered to be of high risk.