scholarly journals Effectiveness and long-term outcomes of different crossing strategies for the endovascular treatment of iliac artery chronic Total occlusions

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Huan Zhang ◽  
Xiangtao Li ◽  
Luyuan Niu ◽  
Yaping Feng ◽  
Xiaoyun Luo ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Target Lesion ◽  
Primary Patency ◽  
Long Term Outcomes ◽  
Chronic Total Occlusions ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Antegrade Approach

Abstract Background The iliac occlusive disease is usually treated with endovascular procedures in recent years. The effectiveness of different crossing approaches for these occlusions is not precisely known. We performed a retrospective study to explore the optimal crossing approach (antegrade versus retrograde) for iliac artery chronic total occlusions (CTOs) and to examine the long-term outcomes. Materials and methods We performed a study on 107 patients (116 iliac occlusive lesions, mean age 64.0 ± 11.1, 88 men) who underwent an iliac CTO endovascular intervention attempted with the use of both crossing strategies but were managed with one final crossing approach between August 2012 and August 2018. Baseline data, procedural characteristics, and outcomes were described. A Cox proportional hazard model and Kaplan-Meier method were developed to assess the differences in the two crossing approaches in terms of the 1-year and 5-year primary patency rates, target lesion revascularization (TLR) and major adverse limb events (MALEs). Results Common iliac artery (CIA) lesions were more likely to be crossed successfully in the retrograde direction (6.8% for antegrade vs. 20.9% for retrograde, p = 0.005), while lesions in the CIA/ external iliac artery (EIA) were more prone to be crossed successfully in the antegrade direction (58.9% for antegrade vs. 39.5% for retrograde, p = 0.016). There were no significant differences in the crossing approach for EIA lesions between the two groups. The two crossing approaches were associated with similar estimates of 1- and 5-year primary patency, TLR and MALE rates. Conclusion The antegrade approach was associated with a higher rate of successful crossing in CIA/EIA CTO lesions, while the CIA-only CTOs were more likely to be crossed successfully with the retrograde approach.

scholarly journals Effectiveness and Long-term Outcomes of Different Crossing Strategies for the Endovascular Treatment of  Iliac Artery Chronic Total Occlusions

2020 ◽  
Author(s):  
Huan Zhang ◽  
Xiangtao Li ◽  
Luyuan Niu ◽  
Yaping Feng ◽  
Xiaoyun Luo ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Target Lesion ◽  
Primary Patency ◽  
Long Term Outcomes ◽  
Chronic Total Occlusions ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Antegrade Approach

Abstract Background: The iliac occlusive disease is usually treated with endovascular procedures in recent years. The effectiveness of different crossing approaches for these occlusions is not precisely known. We performed a retrospective study to explore the optimal crossing approach (antegrade versus retrograde) for iliac artery chronic total occlusions (CTOs) and to examine the long-term outcomes. Materials and Methods: We performed a study on 107 patients (116 iliac occlusive lesions, mean age 64.0±11.1, 88 men) who underwent an iliac CTO endovascular intervention attempted with the use of both crossing strategies but were managed with one final crossing approach between August 2012 and August 2018. Baseline data, procedural characteristics, and outcomes were described. A Cox proportional hazard model and Kaplan-Meier method were developed to assess the differences in the two crossing approaches in terms of the 1-year and 5-year primary patency rates, target lesion revascularization (TLR ) and major adverse limb events (MALEs ). Results: Common iliac artery (CIA ) lesions were more likely to be crossed successfully in the retrograde direction (6.8% for antegrade vs. 20.9% for retrograde, p=0.005), while lesions in the CIA/ external iliac artery (EIA ) were more prone to be crossed successfully in the antegrade direction (58.9% for antegrade vs. 39.5% for retrograde, p=0.016). There were no significant differences in the crossing approach for EIA lesions between the two groups. The two crossing approaches were associated with similar estimates of 1- and 5-year primary patency, TLR and MALE rates. Conclusion: The antegrade approach was associated with a higher rate of successful crossing in CIA/EIA CTO lesions, while the CIA-only CTOs were more likely to be crossed successfully with the retrograde approach.

scholarly journals Effectiveness and Long-term Outcomes of Different Crossing Strategies for the Endovascular Treatment of Iliac Artery Chronic Total Occlusions

2020 ◽  
Author(s):  
Huan Zhang ◽  
Xiangtao Li ◽  
Luyuan Niu ◽  
Yaping Feng ◽  
Xiaoyun Luo ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Target Lesion ◽  
Primary Patency ◽  
Long Term Outcomes ◽  
Chronic Total Occlusions ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Antegrade Approach

Abstract Background: The iliac occlusive disease is usually treated with endovascular procedures in recent years. The effectiveness of different crossing approaches for these occlusions is not precisely known. We performed a retrospective study to explore the optimal crossing approach (antegrade versus retrograde) for iliac artery chronic total occlusions (CTOs) and to examine the long-term outcomes. Materials and Methods: We performed a study on 107 patients (116 iliac occlusive lesions, mean age 64.0±11.1, 88 men) who underwent an iliac CTO endovascular intervention attempted with the use of both crossing strategies but were managed with one final crossing approach between August 2012 and August 2018. Baseline data, procedural characteristics, and outcomes were described. A Cox proportional hazard model and Kaplan-Meier method were developed to assess the differences in the two crossing approaches in terms of the 1-year and 5-year primary patency rates, target lesion revascularization (TLR ) and major adverse limb events (MALEs ). Results: Common iliac artery (CIA ) lesions were more likely to be crossed successfully in the retrograde direction (6.8% for antegrade vs. 20.9% for retrograde, p=0.005), while lesions in the CIA/ external iliac artery (EIA ) were more prone to be crossed successfully in the antegrade direction (58.9% for antegrade vs. 39.5% for retrograde, p=0.016). There were no significant differences in the crossing approach for EIA lesions between the two groups. The two crossing approaches were associated with similar estimates of 1- and 5-year primary patency, TLR and MALE rates. Conclusion: The antegrade approach was associated with a higher rate of successful crossing in CIA/EIA CTO lesions, while the CIA-only CTOs were more likely to be crossed successfully with the retrograde approach.

scholarly journals Effectiveness and Long-term Outcomes of Different Crossing Strategies for the Endovascular Treatment of Iliac Artery Chronic Total Occlusions

2020 ◽  
Author(s):  
Huan Zhang ◽  
Xiangtao Li ◽  
Luyuan Niu ◽  
Yaping Feng ◽  
Xiaoyun Luo ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Target Lesion ◽  
Primary Patency ◽  
Long Term Outcomes ◽  
Chronic Total Occlusions ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Antegrade Approach

Abstract Background: The iliac occlusive disease is usually treated with endovascular procedures in recent years. The effectiveness of different crossing approaches for these occlusions is not precisely known. We performed a retrospective study to explore the optimal crossing approach (antegrade versus retrograde) for iliac artery chronic total occlusions (CTOs) and to examine the long-term outcomes. Materials and Methods: We performed a study on 107 patients (116 iliac occlusive lesions, mean age 64.0±11.1, 88 men) who underwent an iliac CTO endovascular intervention attempted with the use of both crossing strategies but were managed with one final crossing approach between August 2012 and August 2018. Baseline data, procedural characteristics, and outcomes were described. A Cox proportional hazard model and Kaplan-Meier method were developed to assess the differences in the two crossing approaches in terms of the 1-year and 5-year primary patency rates, target lesion revascularization (TLR ) and major adverse limb events (MALEs ). Results: Common iliac artery (CIA ) lesions were more likely to be crossed successfully in the retrograde direction (6.8% for antegrade vs. 20.9% for retrograde, p=0.005), while lesions in the CIA/ external iliac artery (EIA ) were more prone to be crossed successfully in the antegrade direction (58.9% for antegrade vs. 39.5% for retrograde, p=0.016). There were no significant differences in the crossing approach for EIA lesions between the two groups. The two crossing approaches were associated with similar estimates of 1- and 5-year primary patency, TLR and MALE rates. Conclusion: The antegrade approach was associated with a higher rate of successful crossing in CIA/EIA CTO lesions, while the CIA-only CTOs were more likely to be crossed successfully with the retrograde approach.

scholarly journals Effectiveness and Long-term Outcomes of Different Crossing Strategies for the Endovascular Treatment of Complex Iliac Artery Chronic Total Occlusions

2020 ◽  
Author(s):  
Huan Zhang ◽  
Xiangtao Li ◽  
Luyuan Niu ◽  
Yaping Feng ◽  
Xiaoyun Luo ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Target Lesion ◽  
Primary Patency ◽  
Long Term Outcomes ◽  
Chronic Total Occlusions ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Antegrade Approach

Abstract Purpose To explore the optimal crossing approach (antegrade versus retrograde) for iliac artery chronic total occlusions (CTOs) and to examine the long-term outcomes. Materials and Methods We performed a study on 107 patients (116 iliac occlusive lesions, mean age 64.0±11.1, 88 men) who underwent an iliac CTO endovascular intervention attempted with the use of both crossing strategies but were managed with one final crossing approach between August 2012 and August 2018. Baseline data, procedural characteristics, and outcomes were described. A Cox proportional hazard model and Kaplan-Meier method were developed to assess the differences in the two crossing approaches in terms of the 1-year and 5-year primary patency rates, TLR (target lesion revascularization) and MALEs (major adverse limb events). Results CIA (common iliac artery) lesions were more likely to be crossed successfully in the retrograde direction (6.8% for antegrade vs. 20.9% for retrograde, p=0.005), while lesions in the CIA/EIA (external iliac artery) were more prone to be crossed successfully in the antegrade direction (58.9% for antegrade vs. 39.5% for retrograde, p=0.016). Considering EIA lesions, there were no significant differences in the crossing approach between the two groups. The two crossing approaches were associated with similar estimates of 1- and 5-year primary patency, TLR and MALE rates. Conclusion The antegrade approach was associated with a higher rate of successful crossing in CIA/EIA CTO lesions, while the CIA-only CTOs were more likely to be crossed successfully with the retrograde approach.

Remote Iliac Artery Endarterectomy: A Case Series and Systematic Review

2018 ◽  
Vol 25 (1) ◽  
pp. 140-149 ◽  
Author(s):  
Joost A. Bekken ◽  
Sanne W. de Boer ◽  
Rogier van der Sluijs ◽  
Hidde Jongsma ◽  
Jean-Paul P. M. de Vries ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Option ◽  
Iliac Artery ◽  
English Language ◽  
Case Series ◽  
External Iliac Artery ◽  
Primary Patency ◽  
Long Term Results ◽  
Secondary Patency

Purpose: To evaluate the long-term results of remote iliac artery endarterectomy (RIAE) in 2 vascular referral centers and review existing literature. Methods: A retrospective analysis was conducted of 109 consecutive patients (mean age 64.2±10.7 years; 72 men) who underwent 113 RIAE procedures for lower limb ischemia from January 2004 to August 2015 at 2 vascular centers. The majority of limbs (82, 72.6%) had TASC II D lesions (31 TASC II C). Primary outcome measures were primary, assisted primary, and secondary patency. A comprehensive literature search was performed in the PubMed and EMBASE databases to identify all English-language studies published after 1990 reporting the results of RIAE. Results: Technical success was achieved in 95 (84.1%) of the 113 procedures. The complication rate was 13.7%, and 30-day mortality was 0%. At 5 years, primary patency was 78.2%, assisted primary patency was 83.4%, and secondary patency was 86.7%. Hemodynamic success was obtained in 91.7% of patients, and clinical improvement was observed in 95.2%. Freedom from major amputation was 94.7% at 5 years. The systematic review comprised 6 studies including 419 RIAEs, and pooled data showed results similar to the current study. Conclusion: For external iliac artery occlusions extending into the common femoral artery, RIAE appears to be a valuable hybrid treatment option. It combines acceptable morbidity and low mortality with good long-term patency. It has some advantages over an open surgical iliofemoral bypass or complete endovascular revascularization and could be the best treatment option in selected cases.

Acute and Midterm Outcomes of Antegrade vs Retrograde Crossing Strategies for Endovascular Treatment of Iliac Artery Chronic Total Occlusions

2019 ◽  
Vol 26 (3) ◽  
pp. 342-349 ◽  
Author(s):  
Damianos G. Kokkinidis ◽  
T. Raymond Foley ◽  
Ryan Cotter ◽  
Prio Hossain ◽  
Bejan Alvandi ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Regression Models ◽  
Target Lesion ◽  
Retrograde Approach ◽  
Initial Attempt ◽  
Iliac Arteries ◽  
Chronic Total Occlusions ◽  
Logistic Regression Models ◽  
Antegrade Approach ◽  
Procedural Complications

Purpose: To examine whether an antegrade or retrograde crossing strategy for treatment of iliac artery chronic total occlusions (CTOs) is associated with differences in procedural or midterm outcomes. Materials and Methods: A dual-center retrospective cohort study was conducted in 168 patients (mean age 66.4±10.6 years; 116 men) treated for CTOs in 110 common iliac arteries (CIA), 52 external iliac arteries (EIA), and 26 combined CIA/EIAs. Logistic regression models were developed to determine the association between crossing strategy and procedural complications, 1- and 3-year target lesion revascularization (TLR), and major adverse limb events (MALE). Results are presented as the odds ratio (OR) and 95% confidence interval (CI). Results: An initial antegrade strategy was more common for EIA CTOs (p<0.005), and an initial retrograde strategy was more often used in CIA (p<0.005) and combined CIA/EIA (p<0.005) CTOs. Crossover to an alternate approach was required in 27.6% of initial antegrade attempts and 9.6% of initial retrograde attempts. EIA CTOs were the most likely lesions to be treated successfully with the initial attempt (either strategy). In all, 123 (65.4%) lesions were successfully crossed with a final retrograde approach and 65 with a final antegrade approach. Overall target lesion success was high for both groups (95.1% vs 93.2%, p=0.456). Lesions treated with a final retrograde approach were shorter (75.3±34.9 vs 87.6±31.3 mm, p=0.005) and were more likely to be treated with a reentry device (34.2% vs 9.2%, p<0.001) and with balloon-expandable stents (39.2% vs 17.7%, p=0.005). The final antegrade approach was associated with a lower risk of target lesion complications (OR 0.07, 95% CI 0.01 to 0.81, p=0.034). The two crossing approaches were associated with similar estimates of 1- and 3-year TLR and MALE. Conclusion: A final antegrade approach was associated with lower rates for complications but the 2 approaches were similar in terms of lesion success, TLR, and MALE. The EIA CTOs were more likely to be treated with an antegrade approach and more likely to be crossed successfully with the initial approach irrespective of the crossing direction.

scholarly journals Results From the VISIBILITY Iliac Study: Primary and Cohort Outcomes at 9 Months

2017 ◽  
Vol 24 (3) ◽  
pp. 342-348 ◽  
Author(s):  
John H. Rundback ◽  
Patrick Peeters ◽  
Jon C. George ◽  
Michael R. Jaff ◽  
Peter L. Faries
Keyword(s):  
Iliac Artery ◽  
Ankle Brachial Index ◽  
External Iliac Artery ◽  
Patient Characteristics ◽  
The United States ◽  
Target Lesion ◽  
Primary Patency ◽  
Specific Patient ◽  
Target Vessel Revascularization ◽  
Primary Stenting

Purpose: To evaluate the safety and effectiveness of primary stenting of the common (CIA) or external iliac artery (EIA) using the Visi-Pro Balloon-Expandable Peripheral Stent System for treatment of stenotic, restenotic, or occluded lesions. Methods: Between 2011 and 2012, 75 patients (mean age 64.2±8.9 years; 46 men) with Rutherford category 2–4 ischemia and atherosclerotic lesions ≤10 cm in length underwent iliac artery stenting at 17 centers in the United States and Europe. The primary outcome of the study was the major adverse event (MAE) rate at 9 months postprocedure [composite of periprocedural death, in-hospital myocardial infarction, clinically driven target lesion revascularization (CD-TLR), and amputation of the treated limb]. Secondary outcomes included 30-day MAE rate, 9-month primary patency, changes in ankle-brachial index (ABI) and the Walking Impairment Questionnaire at 30 days and 9 months postprocedure, device success, and clinically driven target vessel revascularization (CD-TVR) at 30 days and 9 months. Outcomes in specific patient cohorts (ie, gender, stent location, calcification severity, and lesion grade) were analyzed. Results: Eighty-one stents were implanted in 61 CIA and 15 EIA lesions (41 with moderate/severe calcification). The mean lesion treated length was 29.3±13.9 mm. All devices were successfully deployed. MAE occurred in 3 (4.0%) of 75 subjects at 9 months. Primary patency and freedom from CD-TVR at 9 months were both 95.8%. ABI improved from 0.67±0.14 at baseline to 0.94±0.14 and 0.96±0.16 at 30 days and 9-month follow-up, respectively (p<0.001 for both). There were no differences with respect to any of the analyzed patient characteristics, including gender. Conclusion: Nine-month results of the VISIBILITY Iliac stent study ( ClinicalTrials.gov identifier NCT01402700) demonstrated safety and effectiveness for the treatment of atherosclerotic CIA and EIA lesions with the Visi-Pro stent across all treated cohorts.

Long-term outcomes after re-entry device use for recanalization of common iliac artery chronic total occlusions

2018 ◽  
Vol 92 (3) ◽  
pp. 526-532 ◽  
Author(s):  
Damianos G. Kokkinidis ◽  
Bejan Alvandi ◽  
Ryan Cotter ◽  
Prio Hossain ◽  
T. Raymond Foley ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Common Iliac Artery ◽  
Long Term Outcomes ◽  
Chronic Total Occlusions ◽  
Device Use

Percutaneous Endoluminal Treatment of Iliac Occlusions: Long-Term Follow-up in 105 Patients

1998 ◽  
Vol 5 (3) ◽  
pp. 228-235 ◽  
Author(s):  
Michel Henry ◽  
Max Amor ◽  
Gérard Ethevenot ◽  
Isabelle Henry ◽  
Bernard Mentre ◽  
...  
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Primary Patency ◽  
Long Term Results ◽  
Lesion Length ◽  
Secondary Patency ◽  
Long Term Follow Up ◽  
Table Analysis ◽  
Percutaneous Recanalization

Purpose: To evaluate the long-term results of percutaneous recanalization techniques in occluded iliac arteries. Methods: Percutaneous recanalization was attempted in 105 patients (97 men; mean age 56 years, range 34 to 80) with iliac occlusions using thrombolysis (n = 15), excimer laser (n = 4), mechanical thrombectomy (n = 16), balloon angioplasty alone (n = 23), and angioplasty plus stenting (n = 69). The majority of lesions (n = 72) were in the common iliac artery (CIA); 33 were in the external iliac artery (EIA). Results: The primary recanalization rate was 88% (92/105) independent of location (EIA: 90%, CIA: 86%) and lesion length, but dependent on age of thrombus (< 3 months: 100%, > 3 months: 79%, p < 0.02). Complications included 5 (4.8%) cases of distal embolism treated by thromboaspiration or Fogarty balloon embolectomy. Seven (6.7%) early thromboses were treated surgically. Primary and secondary patency rates were calculated at 6 years for all 105 cases and for the 92 recanalized lesions using life-table analysis. Overall, primary patency was 52% (CIA: 58%, EIA: 34%) and secondary 66% (CIA: 74%, EIA: 40%). Lesions < 6 cm had a primary patency of 70%, while those > 6 cm had a 31% rate (p < 0.01). Secondary patencies were 86% and 42%, respectively (p < 0.01). Among recanalized lesions, the primary patency was 61% (CIA: 69%, EIA: 38%) and secondary 77% (CIA: 88%, EIA: 45%; p < 0.05). Lesions < 6 cm had a primary patency rate of 72%, while longer lesions had a primary rate of 44% (p < 0.04); secondary patencies were 89% and 59%, respectively (NS). Primary patency without stent was 57% and with stent 65% (NS); secondary patency without stent was 71% and with stent 82% (NS). Conclusions: Percutaneous recanalization of iliac occlusions represents a true alternative to vascular surgery and a first-line treatment option. Stents have a tendency to improve long-term results and are recommended for routine use in chronic iliac occlusions.

Sign in / Sign up

Export Citation Format

Share Document