Stenting Iliac Arteries — Self-Expanding Stents Treat Peripheral Artery Disease (2022)

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Stenting Iliac Arteries — Self-Expanding Stents Treat Peripheral Artery Disease (1)

March 10 , 2008

Stenting Iliac Arteries — Self-Expanding Stents Treat Peripheral Artery Disease
By Beth W. Orenstein
Radiology Today
Vol. 9 No. 5 P. 20

Peripheral arterial disease (PAD) affects 12% to 20% of Americans over the age of 65. Among the factors that increase the chances of developing the disease are aging, smoking, high blood pressure, diabetes, and obesity. As the population ages and rates of diabetes and obesity rise, the incidence of PAD is also expected to increase.

(Video) External Iliac Artery Balloon Angioplasty and Stenting (Alan B. Lumsden, MD, M. Mujeeb Zubair, MD)

PAD often occurs in the iliac arteries, which carry blood from the abdominal aorta to the legs and feet. Often the first sign of iliac artery disease is claudication, or cramplike pain in the leg or thigh.

Some people affected by PAD experience pain when walking or exercising, explains Katharine L. Krol, MD, FSIR, FACR, director of interventional radiology at CorVasc MD’s in Indianapolis. “People with mild cases will say, ‘I used to be able to run five miles, and now I can only run two,’” Krol says. “If it is more severe, they might say they can’t make it to their mailbox and back.” In mild cases, the pain goes away during rest, but in more severe cases, it can be more constant.

In its most severe form, PAD can cause painful sores on a patient’s toes and feet, and, if the circulation does not improve, the ulcers will become dry, gray or black, and eventually gangrenous.

Treatment depends on the location and severity of the blockage, symptoms, and the patients’ overall health. Typically, treatment includes lifestyle changes such as losing weight, stopping smoking, and exercising, as well as taking medications that lower cholesterol, blood pressure, and the risk of clots. If the symptoms are severe enough to require intervention, angioplasty and stenting are often the first choice because they are a minimally invasive option, according to Krol. Asymptomatic patients are not treated with stents.

Old Treatment, New Stents
Treating PAD with stents is not new. “We’ve been doing it 17, 18 years now,” Krol says, but new stents have been developed. Krol was the lead author of a study published in the January issue of the Journal of Vascular and Interventional Radiology about the clinical evaluation of the self-expanding Zilver vascular stent for symptomatic iliac artery disease.

The study, which involved 151 patients at 24 investigative sites in the United States, concluded that the Zilver vascular stent, which is made by Cook Group Inc. in Bloomington, Ind., is safe and effective as an adjunct to percutaneous transluminal angioplasty for treating symptomatic disease of the iliac arteries.

Krol says the study was significant because “there has been a lot of talk lately from the [FDA] and others about the off-label use of stents in blood vessels. So this trial was very timely and excellent [because] now these stents have FDA indication for use in arteries.”

(Video) 3D Medical Animation: Vascular Stent System for Leg Arteries

Richard Saxon, MD, FSIR, of the San Diego Cardiac & Vascular Institute, who was also involved in the study, says the Zilver stent is one of several stents approved by the FDA for iliac arteries.

Smaller Stents and Catheters
The first stent for PAD was approved in 1988, according to Barry T. Katzen, MD, FACR, FACC, founder and medical director of Baptist Cardiac & Vascular Institute in Miami and another physician who participated in the study. Earlier generations of stents required bigger catheters, he says.

“One of the things that has happened over time is that the results have improved with each iteration of stent and each clinical trial,” Katzen says. “Part of that is the result of the technology itself, and part of it is related to the improved skill of the operators.”

Before stenting, patients who require intervention for iliac artery issues would have to undergo surgery for bypass grafts. “Because the abdominal aorta splits into the two iliac arteries just beneath the belly button, the surgery would involve a large abdominal incision for the most part,” Krol says.

Balloon angiography to open the clogged arteries was a great boon to many patients, especially those who couldn’t undergo surgery. “When stents came along, it was the icing on the cake,” Krol says. “It took us from [a] 75% to 80% primary success rate to now almost a 100% primary success rate getting that vessel open and getting flow restored.”

Katzen believes that stenting for iliac artery disease is an exciting area for vascular therapy, though some types of blockages such as those that involve very large segment blockages or affecting the aorta may still require open surgery. “But probably 90% of all patients with PAD can be treated without open surgery,” he says.

Self-Expanding Stents
Most practices have gone from using balloon-expandable to self-expanding stents, Krol says. Self-expanding stents such as the Zilver are flexible and can meander around the curves normally found in the iliac arteries, she explains. “There really isn’t any difference in the success rate or long-term patency, but when we moved from technology where you could accurately measure the vessel to digital subtraction imaging and trying to measure vessels that way, self-expandings are a little more forgiving as to not having to have it exactly right on the millimeter.”

(Video) AtlasTM is a peripheral self-expanding stent

Stents also are a benefit to patients with multilevel disease, Krol says. In some patients, opening the iliac will not be enough to restore blood flow; they will also need bypass surgery. “But whenever you have to go with the bypass from the aorta in the belly all the way down, below the knee or wherever you have to go with the bypass, stenting the iliac makes the bypass shorter and typically not involving an incision outside the abdomen. This is one stage in fixing the overall problem that is much less invasive and that makes the invasive surgery easier,” she says.

Only those patients who have symptoms will undergo stenting. “Generally, you need a narrowing that is greater than 70% for it to be significant,” Katzen says. Most people, Krol adds, feel better immediately after the artery is opened.

The procedure, which takes roughly 60 to 90 minutes and is performed with local anesthesia, is fairly simple and similar to placing stents in clogged arteries in other parts of the body, according to Katzen. “It depends on how extensive the blockage is and also whether you’re doing the diagnostic studies at the same time,” Krol says.

At Krol and Katzen’s practices, patients usually undergo angioplasty and stenting, if they are found to be necessary, at the same time. “We do mostly catheter-directed angiography so that when a patient comes in for the angiogram and we are in the artery, we go ahead and do the iliac stent at the same time, and they go home the same day,” Krol says. “At our practice, we tend to do it all at once so that the patient doesn’t have go through a similar procedure twice.”

Occasionally, the diagnostic and treatment procedures are separated. If, for example, the patient has renal insufficiency “and you want to limit the dye load, or you may look at the anatomy and say, ‘This isn’t ideal for a stent.’ Then you might want to stop to talk to a surgeon to see if there is a better option for the patient,” Krol says.

Sometimes, however, the reverse is true, she adds. A patient is not an ideal candidate for open surgery and “so you really want to try stenting.”

Up and About
Most patients are ambulated roughly two to six hours after the stenting procedure. “Depending on your institution and what environment your patients are in, they can generally go immediately back to normal activities,” Katzen says. “Compared to open surgery, it’s a pretty dramatic difference.”

(Video) R2P™ MISAGO® RX Self-expanding Peripheral Stent In-Service Video

“Our primary success rate is almost 100%,” Krol says. “We can almost always get that vessel open. I can’t remember the last time we couldn’t get one open.”

The secondary patency rate varies, she adds. A lesion that is very short and has good inflow and outflow will do well and have a high long-term patency rate. Those where the iliac artery is tiny and diffusely diseased “and everything above and below it is diseased won’t do as well long term. They have more of a chance that they will become blocked again.”

The good news is that if the artery gets blocked again, the procedure can be repeated. “Even people that come in with the stent occluded, a lot of times, we will be able to open that back up,” Krol says.

In the Zilver trial, the acute procedure success rate and 30-day clinical success rate were 98% and 94%, respectively. The nine-month patency rate, measured with duplex ultrasonography, was 92.9%. Significant improvement was seen in the ankle brachial index, which compares blood pressure in the ankle to the arm, and walking distance and walking speed scores relative to preprocedural values at one month and nine months follow-up.

Katzen says the success rate at his institution is also roughly 98% to 99%. With a 100% blockage, the success rate is roughly 93%, he says.

Identifying PAD
One problem with PAD is that it is often misdiagnosed. “People are told they have arthritis or back disease when what they really have is PAD,” Krol says.

PAD is diagnosed by taking a patient history and doing a physical exam. “When patients are telling you their story, you have to recognize the symptoms and say, ‘Ah ha! I wonder if they have good circulation,’” Krol says. “You have to do a physical exam and feel pulses, look at the foot and the skin color, temperature, and capillary refill.”

(Video) Discover the Advanta V12 iliac stenting

“Once we suspect iliac artery disease, it can be detected with computed tomography angiography or magnetic resonance angiography,” Katzen says. “That’s generally the next thing we do.”

— Beth W. Orenstein is a freelance medical writer and frequent contributor to Radiology Today. She works from her home in Northampton, Pa.

FAQs

Do stents work for PAD? ›

A Stent is a wire mesh “scaffold” that is permanently implanted in the artery to keep the artery open and can be combined with angioplasty to treat PAD.

When would you use a self expanding stent? ›

The use of third-generation drug-eluting stents (DES) is currently the preferred method of treatment for different indications in patients with coronary artery disease. Self-expanding stents are routinely used in peripheral arterial disease, like external iliac and femoropopliteal percutaneous interventions.

Is iliac artery a peripheral artery? ›

The iliac arteries branch off of the bottom of the aorta, the large artery coming out of the top of the heart. The iliac arteries are peripheral arteries. Peripheral means they provide blood to parts of the body farther away from the heart.

What is a peripheral artery stent? ›

Peripheral stent implants help hold open an artery so that blood can flow through the blocked or clogged artery., The stent—a small, lattice-shaped wire mesh tube, props open the artery and remains permanently in place. The stent is passed through the catheter and implanted in the peripheral artery.

Can you recover from peripheral artery disease? ›

Contents. There's no cure for peripheral arterial disease (PAD), but lifestyle changes and medicine can help reduce the symptoms. These treatments can also help reduce your risk of developing other types of cardiovascular disease (CVD), such as: coronary heart disease.

How long do peripheral artery stents last? ›

A stent is a tiny tube we place in an artery, blood vessel, or other duct (such as the one that carries urine) to hold the tubes open. A stent is left in permanently. Most stents are made of metal or plastic mesh-like material.

What is self expanding stent? ›

A self-expandable metallic stent (or SEMS) is a metallic tube, or stent that holds open a structure in the gastrointestinal tract to allow the passage of food, chyme, stool, or other secretions related to digestion.

What are the disadvantages of stents? ›

damage to the artery where the sheath was inserted. allergic reaction to the contrast agent used during the procedure. damage to an artery in the heart. excessive bleeding requiring a blood transfusion.

Whats the difference between a balloon and a stent? ›

Opening Arteries Without Open-Heart Surgery

Balloon angioplasty is a minimally invasive cardiac catheterization procedure used to open narrow and blocked arteries. Heart stents are tiny lattice-shaped metal tubes that serve as scaffolding to keep the artery open.

What are the symptoms of iliac artery disease? ›

Aortoiliac occlusive disease is a type of vein condition in the legs. It occurs when the iliac artery that brings blood to your legs becomes narrow or blocked by plaque. Symptoms can include pain, numbness, or cramping in the lower limbs, gangrene in the feet, and erectile dysfunction (ED) in men.

How long do iliac vein stents last? ›

They are made to be permanent — once a stent is placed, it's there to stay. In cases when a stented coronary artery does re-narrow, it usually happens within 1 to 6 months after placement.

How serious is a blocked iliac artery? ›

As atherosclerosis progresses, the aortic artery can be completely blocked by plaque or by a blood clot lodged in a narrowed section. When this happens, the tissues below the blockage will not receive enough blood or oxygen, and will eventually die, causing a condition called gangrene.

Does walking help peripheral artery? ›

Walking is especially good for you

Several randomized clinical trials have shown that walking can make a real difference for people with peripheral artery disease, says Emile R. Mohler, III, MD, late Director of Vascular Medicine at Penn Medicine. “Any other exercise is fine.

What causes peripheral artery disease? ›

Peripheral artery disease is often caused by a buildup of fatty, cholesterol-containing deposits (plaques) on artery walls. This process is called atherosclerosis. It reduces blood flow through the arteries. Atherosclerosis affects arteries throughout the body.

How successful are stents in legs? ›

Patients who received stents had a 31 percent risk of needing another procedure to restore blood flow within 24 months, while those who received a bypass had a 54 percent chance of needing another intervention. The researchers found that women were twice as likely as men to need a second operation.

What is the best treatment for peripheral artery disease? ›

Physical Activity. An effective treatment for PAD symptoms is regular physical activity. Your doctor may recommend supervised exercise training, also known as supervised exercise therapy (SET). You may have to begin slowly, but simple walking regimens, leg exercises and treadmill exercise programs can ease symptoms.

Can you live a long life with peripheral artery disease? ›

You can still have a full, active lifestyle with peripheral artery disease, or PAD. The condition happens when plaque builds up in your arteries. This makes it harder for your arms, legs, head, and organs to get enough blood. Although it's serious and can sometimes be painful, there are lots of ways to slow it down.

How long can you live with peripheral vascular disease? ›

If left untreated, PAD can result in the need for a major amputation of the foot or leg. This is most concerning because the life expectancy for 60% of PAD amputee patients is only 2 to 5 years.

Do stents shorten your life? ›

But studies show that stable angina can be well controlled with medication. And researchers have found that stenting chest pain patients doesn't help them live longer or reduce their risk of disease — in fact, heart attacks and strokes can be potentially deadly side effects of stent procedures.

Can you live a normal life after a stent? ›

It's important to remember that you can live a full and active life with a coronary stent. You can find some general guidelines about returning to working, resuming your everyday activities and making some heart-healthy lifestyle changes below.

How long can you live after stents? ›

Survival was 99.5% at 1 year and 97.4% after 5 years; "event free survival" was 84.6% at 1 year and 65.9% after 5 years; "ischemia free survival" was 84.6% at 1 year and 44.8% after 5 years.

How do balloon expandable stents work? ›

Balloon Expandable vs. Self Expanding Stents - YouTube

What is a balloon expandable stent? ›

The Assurant Cobalt® Balloon Expandable Stent System is designed to treat restenosis in the iliac artery by opening clogged arteries and restoring blood flow. The stent provides support to the artery after angioplasty.

What are the different types of stents? ›

There are two types of stents: bare-metal stent and drug-eluting stent. The latter are used more frequently and are coated with medication that helps keep a blocked artery open longer.

Which artery is the most common to have blockage? ›

When this happens, patients may go into cardiac arrest. Statistically, Niess said widow-makers are more likely to lead to brain injury and irregular heartbeat. Although blockages can occur in other arteries leading to the heart, the LAD artery is where most blockages occur.

What is the biggest risk of a stent procedure? ›

About 1% to 2% of people who have a stent may get a blood clot where the stent is placed. This can put you at risk for a heart attack or stroke. Your risk of getting a blood clot is highest during the first few months after the procedure.

What to avoid after having a stent? ›

In most cases, you'll be advised to avoid heavy lifting and strenuous activities for about a week, or until the wound has healed.
  • Driving. You shouldn't drive a car for a week after having a coronary angioplasty. ...
  • Work. ...
  • Sex.

What happens to plaque after stent? ›

Afterward, the balloon and tube are removed. In some cases, plaque is removed during angioplasty. A catheter with a rotating shaver on its tip is inserted into the artery to cut away hard plaque. Lasers also may be used to dissolve or break up the plaque.

How much blockage requires a stent? ›

“For a cardiac stent procedure to qualify as a medical necessity, it is generally accepted that a patient must have at least 70% blockage of an artery and symptoms of blockage,” Justice Department attorneys wrote.

Will I feel better after a stent? ›

After receiving a stent, it is normal to feel tired or a bit weak for a few days, and it's not uncommon to experience some pain or soreness at the catheter site. If you received a stent because of a heart attack, you will likely feel tired for several weeks, Patel says.

When is an iliac artery stent needed? ›

During this procedure, a small mesh tube, called a stent, is placed in the artery which keeps the artery open and helps prevent re-narrowing. For patients with severe narrowing with blocked blood flow to the legs, surgery may be needed. There are two types of surgery to treat iliac artery disease.

What causes iliac artery stenosis? ›

Thus, LEAD risk factors are well identified: non-modifiable risk factors such as age, gender, and heredity; and modifiable risk factors such as smoking, hypertension, diabetes, and dyslipidemia (2). It is common to define proximal LEAD and distal LEAD depending on the ischemia area supplied by the damage artery (3).

How do you unblock the iliac artery? ›

Balloon Angioplasty and Stenting

During the procedure, the surgeon makes a puncture with a needle in the groin and advances a long catheter through the femoral artery to the blockage in the iliac artery.

What can I expect after a leg stent? ›

Your Recovery

Your groin or leg may have a bruise or a small lump where the catheter was put in your groin. The area may feel sore for a few days after the procedure. You can do light activities around the house but nothing strenuous for several days. After surgery, blood may flow better throughout your leg.

What are the disadvantages of stents? ›

damage to the artery where the sheath was inserted. allergic reaction to the contrast agent used during the procedure. damage to an artery in the heart. excessive bleeding requiring a blood transfusion.

What is the treatment for PAD in the legs? ›

An effective treatment for PAD symptoms is regular physical activity. Your doctor may recommend supervised exercise training, also known as supervised exercise therapy (SET). You may have to begin slowly, but simple walking regimens, leg exercises and treadmill exercise programs can ease symptoms.

Can you stent a 100% blocked artery? ›

“Patients typically develop symptoms when an artery becomes narrowed by a blockage of 70 percent or more,” says Menees. “Most times, these can be treated relatively easily with stents. However, with a CTO, the artery is 100 percent blocked and so placing a stent can be quite challenging.”

How long does it take to recover from peripheral artery disease? ›

You may have soreness for a few days where your healthcare provider had to cut into your skin. It can take six to eight weeks to recover completely from the surgery. You may only need a few days to recover from your atherectomy.

How successful are stents in legs? ›

Patients who received stents had a 31 percent risk of needing another procedure to restore blood flow within 24 months, while those who received a bypass had a 54 percent chance of needing another intervention. The researchers found that women were twice as likely as men to need a second operation.

What causes peripheral artery disease? ›

Peripheral artery disease is often caused by a buildup of fatty, cholesterol-containing deposits (plaques) on artery walls. This process is called atherosclerosis. It reduces blood flow through the arteries. Atherosclerosis affects arteries throughout the body.

Do stents shorten your life? ›

But studies show that stable angina can be well controlled with medication. And researchers have found that stenting chest pain patients doesn't help them live longer or reduce their risk of disease — in fact, heart attacks and strokes can be potentially deadly side effects of stent procedures.

Which artery is the most common to have blockage? ›

When this happens, patients may go into cardiac arrest. Statistically, Niess said widow-makers are more likely to lead to brain injury and irregular heartbeat. Although blockages can occur in other arteries leading to the heart, the LAD artery is where most blockages occur.

What is the survival rate after a stent? ›

The composite event-free survival rate was 58.3% in the stent group and 78.2% in the CABG group (p < 0.0001; RR, 1.91;95% CI, 1.60 to 2.28).

Which is the most common location for peripheral artery disease? ›

It is primarily caused by the buildup of fatty plaque in the arteries, which is called atherosclerosis. PAD can happen in any blood vessel, but it is more common in the legs than the arms.

How do you clear your arteries in your legs? ›

Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to your legs. Fatty deposits can build up inside the arteries and block blood flow. A stent is a small, metal mesh tube that keeps the artery open. Angioplasty and stent placement are two ways to open blocked peripheral arteries.

Are there any new treatments for PAD? ›

About half of people who have PAD are asymptomatic, but whether or not it causes symptoms, PAD can indicate systemic atherosclerosis and an increased risk for heart disease and stroke. Many new devices, and new generations of older devices, are now available for less invasive, endovascular treatment of PAD.

Can you live a normal life after having a stent fitted? ›

It's important to remember that you can live a full and active life with a coronary stent. You can find some general guidelines about returning to working, resuming your everyday activities and making some heart-healthy lifestyle changes below.

Which is better bypass or stent? ›

Patients with severe coronary artery disease generally fared better with bypass surgery than with stents to open blocked arteries, according to a major new multinational study led by Stanford Medicine investigators.

Can a blocked artery clear itself? ›

Is it possible to Unclog Arteries Naturally? Although it isn't possible to remove plaque from your arterial walls without surgery, you can halt and prevent future plaque build-up.

Your access to the latest cardiovascular news, science, tools and resources.

In the case of short stenosis/occlusion (<5 cm) of iliac arteries, endovascular therapy gives good long-term patency (>90% over 5 years) with a low risk of complications [5].. Extended infrapopliteal artery disease is mainly seen in diabetic patients, often associated with superficial femoral artery (SFA) lesions (inflow disease).. So far, only one randomised trial, the BASIL trial, has directly compared endovascular therapy to open surgery in CLTI patients [9].. Data from clinical trials reveal that the treatment of infrapopliteal disease with drug-eluting stents (DES) leads to significantly greater patency rates when compared to PTA or BMS.. A recent systematic review and meta-analysis of randomised controlled trials showed that drug-eluting stents in the infrapopliteal arteries were associated with significantly lower rates of restenosis, TLR and amputations, as well as improved wound healing compared with balloon angioplasty and BMS [23].. Several studies investigated peripheral artery stent implantation outcome after 12 months with a DAPT therapy regime of 4-6 weeks.. Among patients with known LEAD (5% of the entire population), ticagrelor significantly reduced the risk of major adverse limb outcomes (acute limb ischaemia and peripheral revascularisation).. Eur J Vasc Endovasc Surg.. Management of peripheral arterial disease (PAD).. Endovascular therapies for peripheral arterial disease: an evidence-based review.

Recent developments in technology have made primary stenting an attractive option.

For patients with symptomatic iliac artery occlusive disease, this includes the primary use of endovascular stents.. In a randomized surgery versus percutaneous intervention study (to treat patients with claudication), open surgery was found to have significantly more risk, with similar improvement in ankle-brachial index and 3-year success, as intervention.1 With inherent mortality and significant morbidity, open surgical bypass appears to be relegated to a secondary role for treating patients without an endovascular option.Initially, percutaneous transluminal angioplasty (PTA) was utilized for focal iliac artery stenoses with acceptable success rates.. Stenting Options The development and introduction of vascular stents revolutionized percutaneous treatment for symptomatic obstructive vascular disease.. Primary success was acceptable and secondary patency of >90% was seen.6 As self-expanding, stainless-steel stents were introduced, more complex disease was able to be treated with similar rates of success.7 Six-year primary patency in patients treated for claudication of nearly 80% has been seen in a more contemporary study utilizing the stainless-steel Wallstent (Boston Scientific Corporation, Natick, MA).8. When utilizing endovascular stents for total iliac occlusions, one can expect early technical success in up to 97% of procedures, with 3-year primary and secondary patency of 70% and 80%, respectively.9. There have been several randomized studies comparing endovascular stenting to stand-alone PTA that have shown stenting to have superior improvement in both hemodynamic parameters and Rutherford class.. The Dutch iliac artery stent study,11 which evaluated direct stent versus primary angioplasty (provisional stenting) did not find significant difference between the direct stent approach compared to provisional stenting for suboptimal angioplasty.. A later report with 5-year follow-up of this study did not find any significant difference between the groups, although repeat intervention was more common in the angioplasty group.12 A meta-analysis of 1,300 patients compared iliac angioplasty and stenting and found significantly higher acute technical success, as well as improved 4-year primary patency in both claudicants and limb-threatening ischemia.13 Iliac stents have even shown good results in aortic bifurcation disease, which can be very problematic for balloon angioplasty.. The development of self-expanding polyethylene terephthatate and polytetrafluoroethylene-covered stents has shown a trend in decreasing the need for repeat procedures in the iliac artery.14 However, as in surgical bypass, minimal luminal diameter will affect patency of these stents and the addition of balloon-expandable polytetrafluoroethylene-covered stents that may maintain a larger luminal diameter should be studied because theoretically this attribute will be beneficial.. Murphy KD, Encarnacion CE, Le VA, et al. Iliac artery stent placement with the Palmaz stent: follow-up study.. Sullivan TM, Childs MB, Bacharach JM, et al. Percutaneous transluminal angioplasty and primary stenting of the iliac arteries in 288 patients.. Tetteroo E, van der Graaf Y, Bosch JL, et al. Randomised comparison of primary stent placement versus primary angioplasty followed by selective stent placement in patients with iliac-artery occlusive disease.. Long-term cardiovascular morbidity, mortality, and reintervention after endovascular treatment in patients with iliac artery disease: The Dutch Iliac Stent Trial Study.

There is insufficient evidence to assess the effects of PTA versus PS for stenotic and occlusive lesions of the iliac artery. From one study it appears that PS in iliac artery occlusions may result in lower distal embolisation rates. More studies are required to come to a firm conclusion.

Background: Atherosclerosis of the iliac artery may result in a stenosis or occlusion, which is defined as iliac artery occlusive disease.. Both percutaneous transluminal angioplasty (PTA) and stenting are commonly used endovascular treatment options for iliac artery occlusive disease.. Alternatively, a stent could be placed primarily to treat an iliac artery stenosis or occlusion (primary stenting, PS).. Objectives: To assess the effects of percutaneous transluminal angioplasty versus primary stenting for stenotic and occlusive lesions of the iliac artery.. Search methods: The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched April 2015) and Cochrane Register of Studies (CRS) (2015, Issue 3).. Selection criteria: We included all randomised controlled trials (RCTs) comparing percutaneous transluminal angioplasty and primary stenting for iliac artery occlusive disease.. One study included mostly stenotic lesions (95%), whereas the second study included only iliac artery occlusions.. Percutaneous transluminal angioplasty (PTA) with selective stenting and primary stenting (PS) resulted in similar improvement in the stage of peripheral arterial occlusive disease according to Rutherford's criteria, resolution of symptoms and signs, improvement of quality of life, technical success of the procedure and patency of the treated vessel.. Authors' conclusions: There is insufficient evidence to assess the effects of PTA versus PS for stenotic and occlusive lesions of the iliac artery.. 2017 Dec;26(4):259-263. doi: 10.1055/s-0037-1606199.

The risk of peripheral artery disease (PAD) increases sharply with age and with exposure to cardiovascular risk factors.

PTA with selective stenting (SS) and primary stenting (PS) resulted in analogous outcomes at the stage of peripheral arterial occlusive disease according to Rutherford's criteria, improving clinical symptoms, and increasing quality of life as well as patency rate.. Stent placement Stent placement is effective in iliac artery lesions because the long-term patency rate of iliac artery stents is excellent.. A recent randomised controlled trial (RCT) by Goode et al demonstrated that primary stenting can improve the technical success rate and lower complications in patients with iliac artery occlusive lesions more than balloon angioplasty [10].. Patients treated with PTA and selective stent placement in the iliac artery had a better outcome on short- and long-term prognosis for symptomatic success compared with patients treated with primary stent placement according to the results of the Dutch iliac stent trial [12].. Compared to PTA alone, stenting improves 3-year patency by 26% in iliac artery lesions; however, if patients continue to smoke, the patency rates are reduced by approximately 50% [13].. For complete occlusion of the aorto-bi-iliac artery, bypass surgery is indicated [13]; however, stent replacement, which has a 1-year patency rate of 85% and a 3-year patency rate of 66%, should be considered in high-risk patients in surgery [14].. In one trial conducted by Martin et al it was demonstrated that primary implantation of self-expanding nitinol stents for the treatment of lesions of the superficial femoral artery was associated with superior anatomical and clinical intermediate-term results in comparison with the currently recommended approach of balloon angioplasty with optional secondary stenting [20].. Even though the long-term patency rate of surgical bypass surgery is significantly superior to that of angioplasty for the treatment of femoropopliteal artery lesions, angioplasty for femoropopliteal artery lesions has many advantages in terms of lower morbidity, mortality and shorter hospital stay if the artery remains open for at least 6 months in CLI, which is enough time for wound healing.. Surgery The superficial femoral artery (SFA) and popliteal artery (PA) are potentially compromised by the high calcium content within the plaque and vessel wall, long length of lesions, and unique dynamic forces found within these arteries; therefore, most of these occlusions are TASC II type C and D lesions, in which surgery is still recommended as the preferred treatment modality.. Stent placement Stenting with self-expanding and balloon-expandable stents is not suitable in the infrapopliteal artery because the lesions are often longer than 10 cm, multiple, the artery is thin, and blood flow is slow.. Infrapopliteal artery Calcified lesions with cutting balloon catheter, long and multiple lesions with long balloon catheter, short infrapopliteal bifurcation lesions with cutting balloon angioplasty. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS).

Angioplasty and stent placement is a procedure that’s used to help open narrow or blocked arteries. Learn more about this minimally invasive procedure.

Angioplasty with stent placement is a minimally invasive procedure used to open narrow or blocked arteries.. Angioplasty is a medical procedure in which your surgeon uses a tiny balloon to widen an artery.. These arteries and other arteries farthest from your heart are known as peripheral arteries.. Angioplasty and stent placement are treatment options for peripheral artery disease (PAD).. If medication and other treatments don’t help your PAD, your doctor may opt for angioplasty and stent placement.. allergic reactions to medication or dye breathing problems bleeding blood clots infection kidney damage re-narrowing of your artery, or restenosis rupture of your artery. However, the procedure may take longer if stents need to be placed in more than one artery.. Angioplasty with stent placement is a minimally invasive procedure that’s done through a small incision, usually in your groin or hip.

Increasing evidence points to first-line use of covered stent grafts for complex iliac artery occlusive disease.

Surgeons continue to pioneer complex. reconstructions for TransAtlantic Inter-Society Consensus. (TASC) C and D lesions by performing “hybrid” interventions. composed of iliac stenting combined with common. femoral and profunda open endarterectomy.. The same group then reported improved success using. stent grafts compared to bare-metal stents for challenging. iliac disease, namely TASC C and D lesions.. Chang et al. published their long-term results, which demonstrated. that hybrid reconstructions of the common femoral and. iliac system have 5-year primary, primary-assisted, and. secondary patencies of 60%, 97%, and 98%, respectively.. Kashyap et al suggested that endovascular techniques. “rivaled” open reconstruction, whereas Piazza et al found. that extensive iliac and common femoral disease can be. effectively treated with hybrid repair (femoral endarterectomy. with iliac stenting) with “similar early and longterm. efficacy” to open repair.. Early results of external iliac artery stenting combined with. common femoral artery endarterectomy.. Long-term results of combined common femoral endarterectomy. and iliac stenting/stent grafting for occlusive disease.

Various peripheral arterial occlusive lesions have traditionally been managed with surgical therapy. However, endoluminal intervention with catheter-based techniques has become quite common and, in many cases, is now the treatment of choice.

The indications for peripheral vascular stent placement in a patient with known peripheral arterial disease (PAD) are the same as those for open intervention.. Stent therapy for carotid stenosis is reserved for patients at high operative risk (eg, intervention for restenosis following previous surgical repair, prior radiation to the neck, high lesions that are difficult to access surgically, or contralateral carotid occlusion). Primary stent placement is generally indicated as initial intervention for iliac, renal, subclavian, and carotid stenosis.. TASC D - Chronic total occlusions of the CFA or the superficial femoral artery (SFA) >20 cm, involving the popliteal artery; chronic total occlusion of the popliteal artery and proximal trifurcation vessels. TASC A lesions - Endovascular therapy is the treatment of choice. Balloon-expandable stents are recommended for ostial lesions, calcified lesions, and short-segment lesions because they can be deployed precisely and exert a stronger radial force; these are ideal for treatment of renal, mesenteric, iliac, and subclavian lesions.. Treatment of Long Femoropopliteal Lesions With Self-Expanding Interwoven Nitinol Stent: 24 Month Outcomes of the STELLA-SUPERA Trial.. Eur J Vasc Endovasc Surg .

Balloon-expandable, intraluminal stenting of the iliac arteries with the Palmaz stent was the subject of a multicenter study for 4 years. A total of 486 patients underwent 587 procedures. Four hundred and five patients had unilateral and 81 had bilateral iliac stent placements. Follow-up ranged from 1 to 48 months (mean 13.3±11 months). Sustained clinical benefit of the treated patients was obtained in 90.9% at 1 year, 84.1% at 2 years, and 68.6% at 43 months. Angiographic patency rate was 92%. Diabetes mellitus and poor runoff had significant negative influence on the clinical outcome. The 10% incidence of procedural complications was not altered by operator experience.

TL;DR: Since angioplasty followed by selective stent placement is less expensive than direct placement of a stent, the former seems to be the treatment of choice for lifestyle-limiting intermittent claudication caused by iliac artery occlusive disease.. TL;DR: The combination of four variables that together predict if PTA is likely to be successful in the management of a patient with peripheral arterial occlusive disease are identified.. TL;DR: PTA of arteries of the lower limbs may be regarded as a valid complementary treatment to vascular surgery in patients with occlusive disease of the peripheral arteries.. Patients with stenoses or occlusions of less than 3 cm had a favorable long-term patency rate of 74%.. TL;DR: The treatment eliminated intermittent claudication in 14 patients and increased exercise tolerance to 500 m in the patient with a limb at risk for amputation before the procedure and the improved condition persisted in all patients during the follow-up of 6-12 months.. The treatment eliminated intermittent claudication in 14 patients and increased exercise tolerance to 500 m in the patient with a limb at risk for amputation before the procedure.

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2. Angioplasty for Treating P.A.D.
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3. self expanding stent
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4. Peripheral Artery Disease
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5. Kissing Stent Conformability
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6. Treating Advanced PAD in a Complex Environment: Preventing Reintervention
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