Factors affecting primary patency of stenting for TransAtlantic Inter-Society (TASC II) type B, C, and D iliac occlusive disease.

BACKGROUND AND OBJECTIVE: The purpose of our study was to evaluate 1- and 2-year results and the influence of risk factors on the outcome in the patients undergoing iliac artery stenting for TASC II type B, C, and D iliac lesions. MATERIALS AND METHODS: In this prospective nonrandomized study conducted between April 15, 2011, and April 15, 2013, 316 patients underwent angiography with a diagnosis of aortoiliac atherosclerotic disease. Of these, 62 iliac endovascular procedures (87 stents) were performed in 54 patients. RESULTS: The indications for revascularization were disabling claudication (Rutherford 2, 5.9%; Rutherford 3, 35.2%), rest pain (Rutherford 4, 22.2%), and gangrene (Rutherford 5, 16.7%). The overall complication rate was 9.2%. The cumulative primary stent patency at 1 and 2 years was 83.0%±5.2% and 79.9%±5.8%, respectively. Early stent thrombosis in ≤30 days was detected in two patients (3.7%). The primary patency rates for the stents ≤61mm at 12 and 24 months were 90.6%±4.5% and 86.6%±5.8%, respectively; those for the stents >61mm were 67.7%±10.9% and 60.2%±12.0%, respectively (P=0.016). The multivariate Cox regression analysis enabled the localization of a stent in both the CIA and the EIA (hazard ratio [HR], 3.3; 95% confidence interval [CI], 1.1-9.5; P=0.021) and poor runoff (HR, 3.2; 95%, CI 1.0-10.0; P=0.047) as independent predictors of decreased stent primary patency. CONCLUSIONS: The localization of a stent in both iliac (CIA and EIA) arteries and poor runoff significantly reduce the primary stent patency. Patients with stents >61mm have a higher risk of stent thrombosis or in-stent restenosis development.

Recent advances in endovascular treatment of aortoiliac occlusive disease.

The rate of endovascular interventions for iliac occlusive lesions is continuously growing. The evolution of the technology supporting these therapeutic measures improves the results of these interventions. We performed a review of the literature to report and appreciate short- and long-term results of endovascular stenting of iliac artery occlusive lesions. The Medline database was searched to identify all the studies reporting iliac artery stenting for aortoiliac occlusive disease (Trans Atlantic Inter-Society Consensus [TASC] type A, B, C, and D) from January 2006 to July 2012. The outcomes were technical success, long-term primary and secondary patency rates, early mortality, and complications. Technical success was achieved in 91% to 99% of patients as reported in all the analyzed articles. Early mortality was described in 5 studies and ranged from 0.7% to 3.6%. The most common complications were access site hematomas, distal embolization, pseudoaneurysms, and iliac artery ruptures. The complications were most often treated conservatively or using percutaneous techniques. The 5-year primary and secondary patency rates ranged from 63% to 88% and 86% to 93%, respectively; and the 10-year primary patency rates ranged from 68% to 83%. In this article, combined percutaneous endovascular iliac stenting and infrainguinal surgical reconstructions and new techniques in the treatment of iliac stent restenosis are discussed. Iliac stenting is a feasible, safe, and effective method for the treatment of iliac occlusive disease. Initial technical and clinical success rates are high; early mortality and complication rates are low. Long-term patency is comparable with that after bypass surgery.

[Subintimal angioplasty: an alternative to open surgery of the lower limb chronic artery occlusion]. / Subintimaline arteriju angioplastika--naujas metodas koju letinei okliuzijai gydyti.

OBJECTIVE: Based on recent literature data, subintimal arterial angioplasty, its indications and contraindications, methods and techniques, treatment results, and perspectives are introduced in this article. During the last two decades, with increasing human lifespan, more and more frequently a combination of progressive chronic lower limb ischemia, which is caused by occlusive disease, and severe condition occurs. In such cases, patients cannot be operated on. In Europe and the United States of America, patients undergo subintimal angioplasty. It is a minimally invasive technique for the treatment of lower limb occlusive disease, when without tissue incision, under local anesthesia, blood flow through damaged artery is normalized. Thus, the occlusion is removed without surgery, patient's quality of life is improved, and survival is increased.

[Subintimal angioplasty for superficial femoral artery occlusions: first experience in Kaunas University of Medicine Hospital]. / Letiniu pavirsiniu slaunies arteriju uzakimu gydymo subintimine angioplastika pirmieji rezultatai Kauno medicinos universiteto klinikose.

OBJECTIVE: To assess prospectively the first experience of subintimal angioplasty of superficial femoral artery occlusions. PATIENTS AND METHODS: Within a period of 36 months, 45 patients with 45 chronic occlusions in superficial femoral artery were treated at Kaunas University of Medicine Hospital. RESULTS: The technical success rate was 84.4%, and four failures were treated by conventional surgery. The following complications occurred: one hematoma at the arterial puncture site, one artery spasm, and two distal embolizations. The mean length of occlusions was 14.2+/-1.4 cm. The mean ankle-brachial index improved from 0.41+/-0.15 to 0.81+/-0.04 after successful subintimal angioplasty (P<0.001). Primary assisted patency rates were 94.7%, 92.1%, 84.2%, 81.6%, and 81.6% at 1, 3, 6, 12, and 24 months, respectively. The limb salvage rates were 100% and 97.8% at 1-3 and 6-12-24 months, respectively. There were no treatment-related amputations. CONCLUSIONS: Subintimal angioplasty of occluded superficial femoral artery is a safe and minimally invasive procedure with a high initial technical success rate, low complication rate, and good early results, and in case of failure, subsequent surgery can be performed.

[The influence of various factors on results of subintimal angioplasty of superficial femoral artery occlusions]. / Slaunies pavirsines arterijos uzakimu subintimines angioplastikos rezultatus lemiantys veiksniai.

OBJECTIVE: To evaluate prospectively the impact of various factors on subintimal angioplasty of superficial femoral artery. PATIENTS AND METHODS: Within a period of 36 months, 44 patients with 45 chronic occlusions in superficial femoral artery were examined. The influence of sex, age, hypertension, diabetes mellitus, smoking, chronic ischemia stage, occlusion length and calcification, flush occlusion of the superficial femoral artery, ischemic cardiac disease, postprocedural medical treatment was evaluated. RESULTS: Arterial calcification had a significant impact on technical success of subintimal angioplasty (p=0.03). Sex, age, smoking, flush occlusion of the superficial femoral artery, and cardiac disease influenced technical and hemodynamic success (p=0.086-0.295). Hypertension, diabetes mellitus, chronic ischemia stage, occlusion length, and postprocedural medical treatment did not significantly influence technical and hemodynamic success (p>0.05). CONCLUSIONS: Arterial calcification had a significant impact on technical success of subintimal angioplasty. Sex, age, smoking, flush occlusion of the superficial femoral artery, and ischemic cardiac disease influenced technical and hemodynamic success. Hypertension, diabetes mellitus, chronic ischemia stage, occlusion length, and postprocedural medical treatment had no statistically significant impact on technical and hemodynamic success.

[The surgical treatment of acute ischemia of the lower limb]. / Apatines galunes umines isemijos chirurginis gydymas.

OBJECTIVE: To analyze the surgical treatment strategy of lower limb acute ischemia and its results in the Department of Vascular Surgery of Kaunas University of Medicine Hospital in the period from 1999 to 2001. MATERIAL AND METHODS: While collecting the data retrospectively there has been determined, that due to the acute ischemia of the limbs there have been operated 244 patients (12.2% of all treated arterial patients). Because of the lower limb acute ischemia there have been operated 142 (7.1%) patients. All embolism and thrombosis have been approved with the operation findings. The comparison of quantitative values was done according to the Student parameter. RESULTS: The acute ischemia in the leg has been caused by: embolism - for 76 (53.5%) patients, acute thrombosis - for 66 (46.5%). Heart diseases have been ascertained in embolism group for 22.4% of patients, in acute thrombosis group - for 6.1%. The localities of embolism - the popliteal artery for 44.7% and femoral artery for 32.9%, acute thrombosis - in the femoral artery for 37.9% and iliac artery for 22.7%. Men experience the acute thrombosis more often (3.5:1), p<0.0001, and women - embolism (2.5:1), p<0.0001. Embolism has been treated with embolectomy, and acute thrombosis with thrombectomy, thrombendarterectomy and the bypass operations. There have been made 4.9% of great amputations, rescued 96.1% of lower limbs with the features of acute ischemia. Total death rate - 4.2%. CONCLUSIONS: The acute ischemia in the leg because of embolism was for 76 patients, the acute thrombosis - for 66 patients. Lower limbs embolism of arteries is more common for women, p<0.0001, acute thrombosis for men, p<0.0001. The death rate is higher in women group with acute ischemia than men, (p=0.1198) and in men group with acute ischemia in the lower limb there are made more great amputations (p=0.04250).