Midterm Outcomes After Endovascular Intervention for Occluded vs Stenosed External Iliac Arteries

Published on Mar 18, 2018in Journal of Endovascular Therapy3.102
· DOI :10.1177/1526602818761664
Damianos G. Kokkinidis13
Estimated H-index: 13
(University of Colorado Denver),
Bejan Alvandi6
Estimated H-index: 6
(UC Davis: University of California, Davis)
+ 6 AuthorsEhrin J. Armstrong49
Estimated H-index: 49
(University of Colorado Denver)
Purpose: To evaluate the association between a chronic total occlusion (CTO) and long-term outcomes among patients undergoing endovascular intervention to the external iliac artery (EIA). Methods: A 2-center retrospective study was conducted of 331 patients (mean age 64.7±12.7 years; 221 men) who underwent endovascular intervention for 481 EIA atherosclerotic lesions between 2006 and 2016. A quarter of the lesions (115, 23.9%) were CTOs. The majority of patients (184, 60.9%) were treated for claudication; 172 (38%) lesions were TransAtlantic Inter-Society Consensus type C or D. Target lesion revascularization (TLR) and major adverse limb event (MALE) rates were compared between lesions with or without an EIA CTO. A Cox proportional hazard model was subsequently developed to determine baseline variables associated with long-term outcomes after successful endovascular intervention of stented EIAs; outcomes are presented as the hazard ratio (HR) and 95% confidence interval (CI). Results: The mean lesion leng...
#1Damianos G. Kokkinidis (University of Colorado Denver)H-Index: 13
#2Ehrin J. Armstrong (University of Colorado Denver)H-Index: 49
: Despite recent advances in endovascular therapy for peripheral artery disease, current technologies remain limited by rates of long-term restenosis and application to complex lesion subsets. This article presents data on upcoming therapies, including novel drug-coated balloons, drug-eluting stents, bioresorbable scaffolds, novel drug delivery therapies to target arteries, techniques to limit postangioplasty dissection, and treatment of severely calcified lesions.
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Purpose: To report a single-center experience with the Outback re-entry device for targeted distal true lumen re-entry during subintimal recanalization of chronic total occlusions (CTOs) and compare the results with a systematic review of the literature. Methods: Between February 2011 and July 2013, 104 Outback devices were employed in 91 patients (mean age 64±9 years; 57 men) for subintimal recanalization of 100 vessels with CTOs after initial failure of spontaneous reentry. Fifty-two cases inv...
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#1Jeffrey Indes (Yale University)H-Index: 17
#2Miles J. Pfaff (Yale University)H-Index: 13
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PurposeTo examine clinical outcomes of endovascular and open bypass treatment for aortoiliac occlusive disease (AIOD).MethodsMultiple databases were systematically searched to identify studies on open and endovascular treatment for AIOD published from 1989 to 2010. Studies were independently reviewed for eligibility criteria. Study selection and assessment of methodological quality were performed by two independent reviewers. Assuming between-study heterogeneity due to biases inherent to observa...
103 CitationsSource
#1David P. Slovut (Montefiore Medical Center)H-Index: 8
#2Evan C. Lipsitz (Montefiore Medical Center)H-Index: 31
Invasive treatment for patients with peripheral artery disease (PAD) has changed dramatically. Medicare claims data from 1996 to 2006 reveal an almost doubling of lower-extremity vascular procedures: The use of endovascular repair increased >3-fold, bypass surgery decreased 42%, and the amputation rate decreased by 29%.1 For patients admitted to hospital for PAD between 1996 and 2005, the likelihood of undergoing surgery decreased from 34.5% to 26.3%.2 Although the rate of bypass is decreasing, ...
36 CitationsSource
#1Rachel C. Danczyk (OHSU: Oregon Health & Science University)H-Index: 4
#2Erica L. Mitchell (OHSU: Oregon Health & Science University)H-Index: 22
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Objective Endovascular stents are accepted therapy for iliac artery stenoses and occlusions. Surgery is the recommended therapy for patients with severe iliac artery disease, including those with the combination of ipsilateral common iliac artery (CIA) and external iliac artery (EIA) stenoses/occlusions. This study compared patient outcomes, including late open conversion rates, for combined ipsilateral CIA and EIA stenting vs CIA or EIA stents alone. Methods Between 1998 and 2010, 588 patients ...
7 CitationsSource
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#2Sanghoon Shin (Yonsei University)H-Index: 19
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Background Subintimal angioplasty (SA) is becoming increasingly accepted as a revascularization technique for chronic arterial occlusive disease. However, its efficacy in iliac artery occlusions has not been established. Therefore, we investigated the procedural and clinical outcomes of subintimal angioplasty in long iliac artery occlusions and compared them with those of intraluminal angioplasty (IA) in nonocclusive stenotic iliac artery lesions. Methods We retrospectively analyzed data from 15...
18 CitationsSource
#1Wei Ye (Peking Union Medical College Hospital)H-Index: 9
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Objectives: The aim of this study was to analyze the technical success and long-term patency of the endovascular treatment of TransAtlantic Inter-Society Consensus (TASC) C and D aorto-iliac arterial lesions. Methods: All studies reporting original series of patients published in English between 2000 and 2010 were enrolled into meta-analysis. Separate meta-analyses were performed for groups with immediate technical success, 12-month patency, and long-term outcomes. Subgroup analyses were perform...
91 CitationsSource
#1Shigeo Ichihashi (Nara Medical University)H-Index: 11
#2Wataru Higashiura (Nara Medical University)H-Index: 12
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Purpose To compare long-term outcomes of systematic primary stent placement between Trans-Atlantic Inter-Society Consensus (TASC)-II C/D disease and TASC-II A/B disease. Methods Between 1997 and 2009, endovascular treatments with primary stent placement were performed for 533 lesions in 413 consecutive patients with iliac artery occlusive disease. Median follow-up term was 72 months (range, 1-144 months). Lesion severity in this retrospective study was classified according to TASC-II as type A i...
59 CitationsSource
#1Raffaele Pulli (UniFI: University of Florence)H-Index: 28
#2Walter Dorigo (UniFI: University of Florence)H-Index: 24
Last. Carlo Pratesi (UniFI: University of Florence)H-Index: 35
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Objectives This study evaluated early and long-term results of endovascular treatment of iliac artery occlusions and compared these outcomes with those in patients treated for stenotic lesions. Methods During a 10-year period ending in January 2010, 223 endovascular procedures to treat aortoiliac occlusive disease (PAD) were performed. All patients were prospectively enrolled in a dedicated database. The intervention was performed for iliac occlusion in 109 patients (group 1) and for iliac steno...
51 CitationsSource
#1Jeffrey Indes (Yale University)H-Index: 17
#2Anant Mandawat (Yale University)H-Index: 7
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Objectives There has been a rapid increase in the number of endovascular procedures performed for peripheral artery disease, and especially aorto-iliac occlusive disease (AIOD). Results from single-center reports suggest a benefit for endovascular procedures; however, these benefits may not reflect general practice. We used a population-based analysis to determine predictors of clinical and economic outcomes following open and endovascular procedures for inpatients with AIOD. Methods All patient...
54 CitationsSource
Cited By7
#1E. Hope Weissler (Duke University)H-Index: 5
#2J. Antonio Gutierrez (Duke University)H-Index: 6
Last. Rajesh V. Swaminathan (Duke University)H-Index: 21
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PURPOSE OF REVIEW Certain comorbidities and lesion characteristics are associated with increased risk for procedural complications, limb events, and cardiovascular events following peripheral vascular intervention (PVI) in patients with peripheral arterial disease (PAD). The purpose of this review is to provide an overview of high-risk modifiable and unmodifiable patient characteristics and its relative impact on clinical outcomes such as amputation risk and mortality. Furthermore, general appro...
#2Vania Tacher (French Institute of Health and Medical Research)H-Index: 17
Last. Hicham Kobeiter (University of Paris)H-Index: 22
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Endovascular approach is the first-choice treatment in patients suffering from aortoiliac occlusions. Nevertheless, standard endoluminal revascularization fails in treating occlusions in about 20% (1) of cases. Thus, subintimal revascularization can be a solution, but it fails in 25% (2) of cases as well. In the last decades, different devices have been created, in order to ease the cross back into the true lumen, when standard subintimal revascularization does not work or risks to occlude impor...
#1Sharon C. Kiang (LLU: Loma Linda University)H-Index: 5
#2Hans K. Boggs (LLU: Loma Linda University)H-Index: 1
Last. Roger T. TomihamaH-Index: 3
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Abstract Background Endovascular treatment of TASC II D aorto-iliac lesions is now an accepted form of revascularization. We sought to demonstrate that native micro-channel recanalization and orbital atherectomy is a successful recanalization method of TASC II D aorto-iliac lesions refractory to standard recanalization techniques. Materials And Methods Four consecutive patients from 2016-2018 with symptomatic TASC-II D Aorto-Iliac Occlusive Disease (AIOD) prohibitive for open bypass and failed t...
#1M. Ben Hammamia (Tunis University)H-Index: 2
#2M. Ben Mrad (Tunis University)H-Index: 2
Last. Raouf Denguir (Tunis University)H-Index: 7
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Resume Introduction Malgre le succes de l’angioplastie de l’artere iliaque, cette technique reste associee a des taux d’amputation non negligeables. Le but de cette etude etait d’identifier les facteurs predictifs d’amputation de membre inferieur apres angioplastie iliaque chez les patients en ischemie critique. Methodes Il s’agit d’une etude retrospective incluant les patients ayant beneficie avec succes d’une angioplastie de l’artere iliaque entre 2014 et 2018. Le critere de jugement principal...
#1Damianos G. Kokkinidis (Albert Einstein College of Medicine)H-Index: 13
#2Ioannis Katsaros (UoA: National and Kapodistrian University of Athens)H-Index: 7
Last. Ehrin J. Armstrong (University of Colorado Denver)H-Index: 49
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Abstract Background Management of iliac artery occlusive disease has changed dramatically over the past few decades. Secondary to advancement in endovascular technologies and techniques, percutaneous interventions have gradually replaced open surgical approaches even for the most difficult cases. In difficult to cross chronic total occlusions (CTO) of the iliac artery, subintimal angioplasty (SIA) with or without the use of re-entry devices (RED) offers a valuable alternative to intra-luminal cr...
3 CitationsSource
#1C. Miller (Leeds Teaching Hospitals NHS Trust)H-Index: 1
#2R. Frood (Leeds Teaching Hospitals NHS Trust)H-Index: 6
Last. C.J. Hammond (Leeds Teaching Hospitals NHS Trust)H-Index: 2
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AIM To provide an update of current practice in iliac artery intervention in the UK. MATERIALS AND METHODS Ninety-nine interventional units across the UK completed online submission forms for iliac angioplasty and stent procedures between 2011 and 2014 (inclusive) for the British Iliac Angioplasty and Stenting (BIAS) IV registry. RESULTS Data for 8,294 procedures were submitted during the study period. A total of 12,253 iliac segments were treated in 10,311 legs. The commonest indication was cla...
1 CitationsSource
#1Damianos G. Kokkinidis (University of Colorado Denver)H-Index: 13
#2T. Raymond Foley (University of Colorado Denver)H-Index: 7
Last. Ehrin J. Armstrong (University of Colorado Denver)H-Index: 49
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Purpose: To examine whether an antegrade or retrograde crossing strategy for treatment of iliac artery chronic total occlusions (CTOs) is associated with differences in procedural or midterm outcom...
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