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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2001 June;42(3):369-74

lingua: Inglese

Value of stent placement during percutaneous transluminal angioplasty of the iliac arteries

Hassen-Khodja R., Sala F., Declemy S., Bouillanne P. J., Batt M., Staccini P.

From ­the Department of Vascular Surgery Hôpital Saint Roch Nice University Hospital, Nice, France


Background. To deter­mine ­the ben­e­fits of ­stents dur­ing per­cut­ane­ous trans­lu­mi­nal angio­plas­ty (­PTA) of ­the ­iliac arter­ies. Retrospective anal­y­sis of ­our 10-­year sur­gi­cal expe­ri­ence ­with ­iliac ­PTA ­from 1988-1997 per­mit­ted com­par­i­son of ­results dur­ing ­two con­sec­u­tive peri­ods: an ­initial peri­od (1988-1992), dur­ing ­which ­stents ­were nev­er ­used, fol­lowed by a sec­ond peri­od (1992-1997), ­when stent­ing ­was per­formed on indi­ca­tion.
Methods. From January 1988 to October 1997, 287 ­iliac ­PTA pro­ce­dures (158 com­mon ­iliac arter­ies, 129 exter­nal ­iliac arter­ies) ­were per­formed on 250 ­patients. Thirty-sev­en ­patients ­had ­two ­iliac ­lesions ­that ­were treat­ed simul­ta­ne­ous­ly. Indications ­for ­PTA includ­ed sten­o­sis (270 cas­es) ­and chron­ic occlu­sion (17 cas­es). Thirty-­one ­patients (12.4%) under­went ­infra-ingui­nal ­bypass in addi­tion to ­PTA ­owing to ­the exis­tence of arte­ri­al ­lesions at ­two lev­els. Two con­sec­u­tive ­patient ­groups ­were ­defined: Group I con­sist­ed of 75 ­patients ­who under­went 86 ­iliac ­PTA pro­ce­dures ­between January 1988 ­and May 1992 with­out ­stent place­ment; Group II con­sist­ed of 175 ­patients ­who under­went 201 ­iliac ­PTA pro­ce­dures ­between June 1992 ­and October 1997, ­when selec­tive stent­ing ­was per­formed. A ­total of 55 ­stents (35 in ­the com­mon ­iliac ­artery, 20 in ­the exter­nal ­iliac ­artery) ­were ­placed in Group II dur­ing ­PTA ­due to unsat­is­fac­to­ry imme­di­ate ­results (dis­sec­tion, resid­u­al sten­o­sis) or occlu­sion.
Results. There ­was no 30-­day mor­tal­ity. There ­were 15 imme­di­ate fail­ures of ­PTA: 8 in Group I (10.7%) ­and 7 in Group II (4%). The cumu­la­tive ­initial suc­cess ­rate ­was 94%. Follow-up ­ranged ­from 3 months to 102 months (­mean 37 months). The cumu­la­tive pri­mary paten­cy ­rate at 4 years ­was 62% (58% in Group I, 64% in Group II). The cumu­la­tive sec­on­dary paten­cy ­rate at 4 years (includ­ing ­patients ­who sub­se­quent­ly under­went ­repeat angio­plas­ty pro­ce­dures) ­was 72% (68% in Group I, 74% in Group II).
Conclusions. Stents ­were an effec­tive ­means ­for treat­ment of ­initial fail­ures of ­PTA in ­patients ­with ­iliac ­artery occlu­sive dis­ease. However, ­there ­were no sig­nif­i­cant dif­fer­enc­es in ­the ­long ­term ­results ­between ­PTA ­alone ­and ­PTA ­with selec­tive ­stent place­ment.

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