Author + information
- Bejan Alvandi1,
- Damianos Kokkinidis2,
- Prio Hossain3,
- T. Raymond Foley4,
- Caitlin Kielhorn2,
- Gagan Singh5,
- Stephen Waldo6 and
- Ehrin Armstrong7
- 1University of California Davis, Davis, California, United States
- 2VA Eastern Colorado Health Care System and University of Colorado, Denver, Colorado, United States
- 3UC Davis Cardiology, Sacramento, California, United States
- 4University of Colorado Hospital, Denver, Colorado, United States
- 5UC Davis Medical Center, Sacramento, California, United States
- 6University of Colorado, Aurora, Colorado, United States
- 7University of Colorado, Denver, Colorado, United States
The literature suggests that external iliac involvement (EIA) involvement is a predictor of iliac artery restenosis and loss of primary patency, possibly due to the presence of more extensive outflow disease. It is uncertain whether chronic total occlusions (CTO) influence the procedural success and long-term patency of EIA intervention. This study aims to evaluate the association between a CTO and long-term outcomes among patients undergoing endovascular intervention to the external iliac artery.
A two-center retrospective study of 481 EIA atherosclerotic lesions undergoing endovascular intervention between 2006 and 2016 was conducted. Target lesion revascularization (TLR) and major adverse limb event (MALE) rates were compared among lesions with or without an external iliac CTO. A Cox proportional hazard model was subsequently developed to determine baseline variables associated with long-term outcomes after successful endovascular intervention of stented EIAs.
During the study period, 331 patients were identified with 481 lesions in the external iliac of which 115 (24 %) were CTOs. The majority of patients (60%) were treated for claudication; 38% of lesions were TASC C/D. The baseline ankle brachial index (ABI) was lower among patients treated for CTOs (0.54 vs. 0.65, p<0.001), and the mean lesion length was longer (84 vs. 50 mm, p<0.001). While overall procedural safety was excellent, vessel perforation (2.7% vs. 0.3%, P=0.02) and distal embolization (2.7% vs. 0.9%, P=0.02) were more common in the CTO group. Among 377 lesions (CTOs, n=93) that were successfully treated with stent placement, the overall 1-year primary patency was 78% and secondary patency was 92%. One-year and five-year TLR rates were 8.2% and 15.4% respectively.CTO intervention was associated with higher 5-year TLR rates in the unadjusted analysis (HR: 1.72; 95% CI: 1.00 – 2.56; P=0.050), but the association did not remain significant after multivariable adjustment.
Intervention to EIA CTOs is associated with increased intraprocedural complexity but with similar long-term outcomes including high patency and low rates of TLR out to five years.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention