Long Term Results Of Stent-Graft Treatment For Diffuse Aorto-Iliac Occlusive Disease

Introduction: Patients with diffuse aorto-iliac occlusive disease or patients with external iliac artery (EIA) occlusions >10cm in length are typically treated with surgical bypass because of limited durability with stent placement (63% primary patency at 12 months in our recent experience). We evaluated our long term results of stent-graft placement as a treatment option in these patients.
Methods: Demographic data for patients undergoing stent-grafting of one or more iliac artery segments was recorded. Technical, clinical, and hemodynamic success, aorto-iliac primary, primary assisted patency and mortality were analyzed using AAVS/SVS criteria.
Results: 78 consecutive patients underwent stent-graft treatment for rest pain (21%), tissue loss (32%) and claudication (47%) of cases. Mean age was 65 years, 42% female, 92% hypertension, 85% CAD, 12% renal insufficiency (Creatinine > 2.0), 27% diabetic and 86% active smokers. TASC C or D disease was present in 90%, complete common or external iliac artery occlusion was present in 47%, and EIA disease requiring treatment was present in 86% of patients. Mean lesion length was 16 +/- 1cm. Technical, hemodynamic and clinical success occurred in all patients in which the lesion could be crossed with a wire. ABI increased from .38 + .02 to .77+ .03. Wall-grafts were used in 58% of cases, Fluency in 42% and Viabahn in three cases. Concomitant CFA endarterectomy was performed in 66%. At 5 year primary and primary assisted patency were 54% and 93% respectively. Primary patency for patients with and without CFA endarterectomy at 5 years was 75% and 37% respectively. Thirty day peri-procedural mortality was 0%. Five year overall mortality rate was 25%.
Conclusion: Late results of stent-graft placement for diffuse aorto-iliac occlusive disease appear acceptable with close follow up. Peri-procedural mortality rate is low.