ORIGINAL ARTICLES   

Giornale Italiano di Chirurgia Vascolare 2002 June;9(2):149-59

Copyright © 2003 EDIZIONI MINERVA MEDICA

language: English, Italian

Direct iliac stenting. Mid- and long-term results

Zennaro M., Zanchetta M., Pedon L., Rigatelli G., Faresin F., Ronsivalle S., Maiolino P.

From the Department of Cardiovascular Diseases Hospital of Cittadella, Cittadella (Padova)

Back­ground. To eval­uate the fea­sibility of ­stenting ­without pre­dil­a­ta­tion and to ­define the ­long-­term out­come of ­direct ­stent place­ment in ­iliac ­arteries.
­Methods. ­From May 1966 to Sep­tember 2000, we per­formed 154 ­direct ­stent place­ments in 116 ­patients ­according to the pro­ce­dure sug­gested by ­Richter and ­described by ­Dorros and ­Mathiak. One hun­dred and ­fifty-­four ­stents ­were ­directly ­implanted ­into ­iliac ­arteries: 121 bal­loon-expand­able ­Palmaz ­stents, 31 ­self-expand­able ­stents (15 Wall­stent, 12 Sym­phony, 2 ­Sinus and 2 Mem­o­therm) 1 Intra­stent, 1 Pas­sager, 1 Per­flex and 1 AVE. ­Long-­term ­patency ­rates ­were deter­mined by ­duplex ultra­so­nog­raphy and angio­graphy.
­Results. Imme­diate pro­ced­ural and clin­ical suc­cess was ­achieved in all ­patients. Angio­gra­phies per­formed in ­patients ­revealed resten­osis ­rates of 0.5%. Sur­vival anal­ysis ­revealed 4-­year pri­mary ­patency ­rates of 96.7%. ­Most res­te­notic ­lesions ­were suc­cess­fully ­treated ­with ­repeat angio­plasty. Nei­ther car­di­o­vas­cular ­risk nor ­other inde­pen­dent var­i­ables ­were sta­tis­ti­cally sig­nif­i­cant to pre­dict pro­ced­ural suc­cess. In accor­dance ­with the lit­er­a­ture, no dif­fer­ences ­were ­found ­either in the pro­ced­ural suc­cess ­rates ­between ­common ­iliac ­arteries (n=89) and ­external ­iliac ­arteries (n=65), or ­between sten­osis (n=142) and occlu­sions (n=12).
Con­clu­sions. We ­regard ­direct ­stent implan­ta­tion in ­iliac ­arteries as a ­safe and effi­cient pro­ce­dure. It ­allows ­long-­term ­patency and is ­more favor­able ­than PTA ­alone. It is prob­ably ­superior to ­direct ana­tomic recon­struc­tion ­both in the treat­ment of sten­osis and occlu­sions. We ­also ­think ­that ­when pri­mary ­stenting is ­planned, ­many ­iliac ath­e­ros­cle­rotic ­lesions can be ­treated ­with con­sid­er­able ­cost effec­tive­ness.