Abstract 3226: Stent Assisted Angioplasty in Infrarenal Aortic and Iliac Stenoses: Acute and Long-Term Results
Objective: Patients with infrarenal aortic and complex bilateral iliac stenoses and occlusions are still considered candidates for surgical aortic biiliac bypass grafting, for high-risk patients there is substantial mortality and morbidity. Aim of this study was to evalute the technical feasibility and long-term efficacy of interventional treatment of infrarenal aortic and iliac stenoses by stent assisted angioplasty.
Methods: In 285 patients (pts.) (male 209, 63±10.2 years) with symptomatic claudication (Rutherford class II (n=125), III (n=130), IV (n=24) or V (n=6)) infrarenal aortic stenoses (n=38) (group A) or iliac stenoses (n=247) (group B) (unilateral n=198, bilateral n=49) were treated by stent-supported angioplasty (n=8). Preinterventional mean diameter stenosis of the infrarenal aorta was 77±14% group A and 87±22% in group B. In overall 334 interventions 457stents(length of the stented segment 38 – 68 in Group A and 2–20cm in Group B) were implanted.
Results: Technical success (residual stenosis <50% and pressure gradient <10mmHg) was achieved in all patients. No major complications (i.e. aortoiliac perforations, severe bleedings) occured postinterventionally. In 50 (17.5%) pts. minor complications (hematomas n=32, aneurysms n= 13, av-fistulas n=3) were detected. A clinical improvement of +1, +2 or +3 according to the AHA criteria was observed in 36, 89 and 95 pts. respectively. Follow-up was performed clinically using standarized treadmill test and colour-coded Doppler ultrasound. After a mean follow-up of 33 months primary patency rate was 92.1% for group A and 90.7% in group B. In 3 pts. of group A and 27 pts. of group B significant restenosis (10.5% for both groups) was observed, 21 of them were treated successfully by repeat PTA, showing a secondary patency of 97.4% for group A and 96.5% for group B, respectively. In 9 pts. aortoiliac bypass grafting was performed.
Conclusion: Stent assisted angioplasty is an effective treatment for infrarenal aortic obstructions as well for complex iliac obstructions providing a high technical feasibility and long-term patency. Even in complex pelvic lesions, especially in high risk patients for surgery, stent-assisted angioplasty should be considered a first line treatment.