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. 2013 Dec 1;82(7):1176-84.
doi: 10.1002/ccd.24975. Epub 2013 May 25.

Mid-term outcomes following endovascular re-intervention for iliac artery in-stent restenosis

Usman Javed  1 , Christopher R Balwanz, Ehrin J Armstrong, Khung-Keong Yeo, Gagan D Singh, Satinder Singh, David Anderson, Gregory G Westin, William C Pevec, John R Laird
Affiliations

Mid-term outcomes following endovascular re-intervention for iliac artery in-stent restenosis

Usman Javed et al. Catheter Cardiovasc Interv. .

Abstract

Objectives: We sought to evaluate the procedural characteristics and clinical outcomes of endovascular repair for iliac artery (IA) in-stent restenosis (ISR).

Background: An increasing percentage of patients with complex IA occlusive disease are treated with an endovascular approach, but the outcomes of IA-ISR have not been well described.

Methods: We analyzed all endovascular procedures for treatment of IA-ISR performed at our institution between July 2006-December 2010. The primary outcome was primary patency, defined as <50% stenosis as assessed by clinical examination and duplex ultrasonography (DUS).

Results: Forty-one lesions in 24 patients who underwent repeated endovascular intervention for treatment of IA-ISR. Most lesions were unilateral and involved the common IA (66%). The mean length of ISR was 30.1 ± 14.1 mm with type I (focal) and II (diffuse) ISR occurring with the greatest frequency (34% and 39%, respectively). All patients underwent balloon angioplasty; adjunctive stenting zwas performed in 27 (66%) of the lesions. Type II ISR lesions more frequently required stenting (13/16 lesions, P = 0.02 compared with other patterns of ISR). Procedural success was 100% with a mean gain of 0.13 in the ankle-brachial index (P = 0.001). The 6- and 12-month primary patency rates were 96% and 82%, respectively. The 12-month primary-assisted patency rate was 90% with clinically driven target lesion revascularization (TLR) in three patients.

Conclusions: Endovascular treatment of IA-ISR using an approach of balloon angioplasty followed by selective stenting is associated with high-patency rates and low rates of TLR at 1 year.

Keywords: iliac artery; in-stent restenosis; peripheral arterial disease.

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Conflict of interest statement

Disclosure: John R. Laird: Consultant/Advisory Board Member for Abbott Vascular, Bard Peripheral Vascular, Boston Scientific, Covi dien, and Medtronic; research support from W.L. Gore and Atrium Medical.

Conflict of interest: Nothing to report.

Figures

Fig. 1
Fig. 1
Subtypes of iliac artery in-stent restenosis. (a) Type I restenosis showing a focal lesion <30 mm in length. (b) Type II restenosis showing diffuse hyperplasia >30 mm in length. (c) Type III restenosis showing proliferative restenosis extending beyond the stent edge. (d) Type IV restenosis showing complete occlusion of a previously placed stent. Inset panels show magnified views of each ISR pattern.
Fig. 2
Fig. 2
Anatomic distribution of lesions by ISR type.
Fig. 3
Fig. 3
Bilateral common iliac artery ISR treated successfully with balloon-expandable covered stents. (a) Bilateral common iliac artery restenosis within two previously placed balloon-expandable noncovered stents. The patient presented with severe claudication despite maximal medical therapy. (b) After initial balloon angioplasty, two balloon-expandable covered stents were simultaneously deployed within the body of the previously placed stents. (c and d) show orthogonal views after stent placement demonstrating excellent angiographic result. Patient remained asymptomatic at 12-month follow-up with no evidence of recurrent ISR by serial duplex ultrasound.
Fig. 4
Fig. 4
Restenosis at 12-month follow-up.
Fig. 5
Fig. 5
TLR at 12-month follow-up.
See this image and copyright information in PMC

Comment in

  • Remember those midterms.
    Butman S. Butman S. Catheter Cardiovasc Interv. 2013 Dec 1;82(7):1185-6. doi: 10.1002/ccd.25242. Catheter Cardiovasc Interv. 2013. PMID: 24255034 No abstract available.

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