1. Self-Expanding, Covered or Balloon-Expandable Stenting for Common Iliac Lesions
James P. Zidar, M.D., F.A.C.C., F.S.C.A.I
Clinical Professor of Medicine
UNC Health Systems
Corporate Chief of Cardiology, Rex Healthcare
President, Rex Heart and Vascular Specialists
Raleigh, North Carolina

2. James P. Zidar, MD
Honoraria:
Medtronic Core Valve

3. Aorto Iliac Lesions
Primary and secondary cumulative patency rates at 36 months were % and 97.7%, respectively.
Balloon-expandable stents had a non-significantly higher patency rate compared to self-expanding stents.
J Endovasc Ther Jun;9(3):363-8

4. How do you make a diseased iliac artery as normal as possible?

5. Benefits of Self-Expandable: Distal External Iliac Lesions

6. Iliac Stent Tips: Watch Out for Pseudolesions From Vessel Kinking
Real Lesion
Fake
Stiff guidewire causing pseudolesions
Easy to lose track which is the true lesion
Left common iliac stented
When in doubt, put soft catheter in and inject

7. Iliac stent options Balloon expandable stents Self-expanding stents
Precise placement, approach ipsilateral
Best for Common iliac and aortic bifurcation lesions.
Excellent radial strength
Often need 7 Fr sheath
Self-expanding stents
Best for long lesions, ectasia, external iliacs.
Can approach ipsi- or contra-lateral
Can place a 10mm stent in a 6 Fr sheath or 5Fr (Cook)
Covered stents
Best for ISR, ectasia or perforation.
Requires larger 7-9 Fr sheaths.

8. Iliac case 54 year old smoker with HTN and dyslipidemia
Bilateral leg weakness and claudication for 4 mon
LE Arterial Duplex suggests severe bilateral inflow disease with minimal SFA-pop disease and 3 vessel runoff
ABIs: right .41 and left .53
No CLI
No rest pain

9. Baseline images

10. Options Send for aorto-bifemoral bypass
PTA and Stent left common iliac and send for fem-fem jump graft
Attempt to recanalize right iliac and perform bilateral iliac stenting
Considerations:
Age, functional status, durability, calcium, technical difficulty, patient’s preference

11. After 8 x 24 mm Genesis stent
Location ?
Size
Length
Runoff

12. Strategies Cross CTO from below Cross from above
Kissing balloons at bifurcation ?
Size
Length

13. Details 6 Fr 22cm Corids Britetip sheath in right CFA .035” QuickCross
.035” Glidewire
Sub-intimal to distal aorta
Options?

14. Details 6 Fr 22cm Corids Britetip sheath in right CFA .035” QuickCross
.035” Glidewire
Sub-intimal to distal aorta
Options?

15. Details - 2 Advanced .035” Glidewire through Omniflush diag catheter
Pulled right sheath back to ext iliac
Advanced wire into sheath
Externalized wire

16. Details - 3
Advanced 5.0 x 60mm Fox Plus balloon up R sheath without difficulty and into left ext iliac
Pulled wire from L groin and advanced .0035” J wire thru balloon via right groin
Advanced a new .035” J wire up L sheath to aorta

17. Details - 4 Dilate right common iliac with 5 x 60mm Fox Plus balloon
What next?
Stent
BE or SE

18. Details - 5 Deploy 7 x 59 mm Cordis Genesis stent in R common iliac
Protect left common iliac with 7 x 40 mm Fox Plus balloon using kissing inflation

20. 7 x 60 mm Absolute Pro in R EIA and dilate with 6 x 60 Fox Plus balloon to 10 atm

21. Final

22. Iliac case: follow-up Seen in clinic on Jan 10th, 2012 - 7 months out
Quit smoking in June, gained 10 lb.
Only 5’3’‘ and 136 lb.
No claudication, occ nocturnal leg cramps
Six month LE arterial Duplex notes ABIs of:
Right .91, left .92.