Early results of stent-grafting to treat diffuse aortoiliac occlusive disease

Abstract

Introduction: Diffuse aortoiliac occlusive disease or isolated external iliac artery occlusion >or=10 cm long typically are treated with surgical bypass grafting because of limited durability of stent placement. We evaluated the results of stent-graft placement as an option for treatment of these diseases.

Methods: Demographic data for patients undergoing stent-grafting in one or more iliac artery segments were recorded. Technical, clinical, and hemodynamic success, and aortoiliac primary and secondary patency were analyzed with Society for Vascular Surgery/American Association for Vascular Surgery criteria.

Results: Thirty-four consecutive patients underwent stent-graft treatment because of rest pain (65%) or tissue loss (35%). Mean patient age was 63 years, and 38% of patients were women. Ninety-one percent of patients had hypertension, 71% had coronary artery disease, 21% had renal insufficiency (serum creatinine > 2.0 mg/dL), and 26% had diabetes; 71% were active smokers. TransAtlantic Inter-Society Consensus C or D disease was present in 85% of patients, complete common or external iliac artery occlusion was present in 41%, and external iliac artery disease requiring treatment was present in 94% of patients. Mean lesion length was 13.7 +/- 8 cm. Technical, hemodynamic, and clinical success was achieved in all patients in whom the lesion could be crossed with a wire. Ankle-brachial index increased from.30 +/-.03 to.59 +/-.04. Self-expanding stent grafts were used (Wallgraft, Boston Scientific, Boston, Mass, in 88% of patients; Viabahn, W. L. Gore, Flagstaff, Ariz, in 12% of patients). Concomitant common femoral endarterectomy was performed in 53% of patients. At 12 months, primary patency was 70% and primary assisted patency was 88%. Four stent grafts became occluded because of distal external iliac artery or proximal common femoral artery disease, which required subsequent common femoral endarterectomy and either external iliac artery stent grafting or extraanatomic bypass grafting. Eighty percent (four of five) of primary patency failures were in patients who did not undergo concomitant common femoral endarterectomy at initial stent graft placement.

Conclusion: Early results of stent-graft placement to treat diffuse aortoiliac occlusive disease appear better than our recent experience with stenting alone. Concomitant common femoral endarterectomy or better assessment of femoral disease may improve durability.