Endovascular management of iliac artery occlusions: extending treatment to TransAtlantic Inter-Society Consensus class C and D patients Christopher D.

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Presentation transcript:

Endovascular management of iliac artery occlusions: extending treatment to TransAtlantic Inter-Society Consensus class C and D patients Christopher D. Leville, MD, Vikram S. Kashyap, MD, Daniel G. Clair, MD, James F. Bena, MS, Sean P. Lyden, MD, Roy K. Greenberg, MD, Patrick J. O’Hara, MD, Timur P. Sarac, MD, Kenneth Ouriel, MD Journal of Vascular Surgery Volume 43, Issue 1, Pages 32-39 (January 2006) DOI: 10.1016/j.jvs.2005.09.034 Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 1 A, Transbrachial aortography documents a TransAtlantic Inter-Society Consensus class D iliac occlusion with right external iliac occlusion and complete occlusion of the left iliac system in a 46-year-old man with disabling claudication. B, Endovascular recanalization was performed with a hydrophilic guidewire and catheter, and femoral access was obtained with ultrasound guidance. Primary stenting with self-expanding nitinol stents with postdeployment balloon angioplasty restored normal pulsatile perfusion to both lower extremities, with palpable pedal pulses. Note that the right hypogastric circulation and other lumbar collateral arteries are preserved. Journal of Vascular Surgery 2006 43, 32-39DOI: (10.1016/j.jvs.2005.09.034) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 2 Kaplan-Meier curve estimates for primary patency, secondary patency, and limb salvage in all patients treated for iliac occlusion over 36 months. Primary patency was 76%, secondary patency was 90%, and limb salvage was 97% at 36 months with an SE less than 10%. Journal of Vascular Surgery 2006 43, 32-39DOI: (10.1016/j.jvs.2005.09.034) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 3 Kaplan-Meier curve estimates for primary patency in patients treated for iliac occlusion stratified by TransAtlantic Inter-Society Consensus (TASC) level over 36 months. No significant difference was found between groups. *SE exceeded 10%. Journal of Vascular Surgery 2006 43, 32-39DOI: (10.1016/j.jvs.2005.09.034) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 4 Kaplan-Meier curve estimates for secondary patency in patients treated for iliac occlusion according to TransAtlantic Inter-Society Consensus (TASC) stratification. There was no significant difference between groups, and patency was greater than 90% for patients with type B and C iliac occlusions. *SE exceeded 10%. Journal of Vascular Surgery 2006 43, 32-39DOI: (10.1016/j.jvs.2005.09.034) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 5 Kaplan-Meier primary patency curves for patients with diabetes (DM) as a variable. Patients with DM had a significantly lower patency when compared with nondiabetics (58% vs 83% at 36 months; P = .049). Journal of Vascular Surgery 2006 43, 32-39DOI: (10.1016/j.jvs.2005.09.034) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions