Immediate stenting of iliofemoral occlusive lesions: A surgeon's early experiences

Abstract

Purpose: To report the early and midterm results of balloon angioplasty and immediate stenting of atherosclerotic iliofemoral lesions in an operating room setting. Methods: Sixty-one patients (41 men, mean age 70 ± 8 years, range 49 to 86) underwent balloon dilation and systematic stenting for 80 stenotic and occlusive lesions in the iliac (n = 47) and superficial femoral (n = 33) arteries in 72 limbs. One hundred two stents (63 VascuCoil, 33 Wallstent, and 6 miscellaneous) were placed. Patients were followed with serial duplex scans at 3-month intervals. Results: Initial technical success by intention-to-treat was 96.2% (77/80) (iliac: 100%, femoral: 90.9% [30/33]). There were 9 (11.3%) procedure-related complications and no deaths. Initial success by anatomic, hemodynamic, and clinical limb criteria were 100%, 95%, and 94.4%, respectively. Thirty procedures were performed for limb salvage with a success rate of 86.7%. Six patients (7 limbs) died during follow-up of unrelated causes. Fifty-nine (81.9%) limbs were available for duplex follow-up over a mean 17.7 months (range 3 to 37). Cumulative patency rates were 87.3% at 2 years for lilac stents and 66.6% at 18 months for femoral stents with an overall 2-year patency rate of 76.3%. The only independent risk factors affecting late patency were the site of angioplasty, stent diameter, lesion grade, and the preoperative ankle-brachial index. Stents placed with a diameter ≤ 5 mm and > 5 mm had 1-year patency rates of 51.0% and 97.6%, respectively (p = 0.004) Conclusions: Iliac and femoral angioplasty and immediate stenting have acceptable midterm patency rates. The patency of femoral stenting is inferior and is adversely affected by stents ≤ 5 mm in diameter.