John C Papakostas1, Petros K Chatzigakis2, Michalis Peroulis3, Stavros Avgos1, George Kouvelos3, Andreas Lazaris4, Miltiadis I Matsagkas5. 1. Vascular Surgery Unit, Department of Surgery, Medical School, University of Ioannina, Ioannina, Greece; Department of Vascular Surgery, "G. Gennimatas", General Hospital of Athens, Athens, Greece. 2. Department of Vascular Surgery, "G. Gennimatas", General Hospital of Athens, Athens, Greece. 3. Vascular Surgery Unit, Department of Surgery, Medical School, University of Ioannina, Ioannina, Greece. 4. Vascular Surgery Unit, 3rd Department of Surgery, Medical School, University of Athens, Athens, Greece. 5. Vascular Surgery Unit, Department of Surgery, Medical School, University of Ioannina, Ioannina, Greece. Electronic address: mimats@cc.uoi.gr.
Abstract
BACKGROUND: To examine the effects of endovascular therapy on the treatment of chronic total occlusions (CTOs) of the iliac arteries. METHODS: We analyzed a cohort of 48 patients (56 limbs) who were treated by endovascular means for iliac artery CTOs during a period of 4 years in 2 vascular surgery centers in Greece. The data were collected retrospectively and were statistically analyzed to report on technical success, morbidity, mortality, primary and secondary patency, and limb salvage through different patient and/or lesion stratifications. RESULTS: Recanalization was accomplished without assisting devices, and primary stenting was always performed. The technical success of the endovascular treatment reached 91%. Patients experienced 4.2% major morbidity and 2.1% mortality rate. Mean ankle-brachial pressure index increased from 0.43 ± 0.12 preoperatively to 0.89 ± 0.11 postoperatively. A median improvement by 3 Rutherford clinical categories was recorded at the first-month follow-up. The estimated limb salvage rate for patients suffering from critical limb ischemia (CLI) was 90.9% at 36 months. Kaplan-Meier analysis estimation for overall primary and secondary patency rate of the treated lesions was 91.4% and 95.3%, respectively at 36 months. There were no statistically significant differences in primary and secondary patency rate between patients in different clinical stages (CLI versus intermittent claudication), as well as between CTO lesions of different Trans-Atlantic Inter-Society Consensus (TASC) categories (TASC B versus TASC C versus TASC D). There was not statistical significant difference between the technical success of TASC B, C, and D lesion groups. CONCLUSIONS: The endovascular treatment of iliac CTOs seems to be safe and feasible. The technical success of the procedure could be high, whereas primary and secondary patency rates seem to be optimal, with remarkable limb salvage rate and overall clinical improvement. A potential shift to an endovascular-first approach for such lesions might be currently justified.
BACKGROUND: To examine the effects of endovascular therapy on the treatment of chronic total occlusions (CTOs) of the iliac arteries. METHODS: We analyzed a cohort of 48 patients (56 limbs) who were treated by endovascular means for iliac artery CTOs during a period of 4 years in 2 vascular surgery centers in Greece. The data were collected retrospectively and were statistically analyzed to report on technical success, morbidity, mortality, primary and secondary patency, and limb salvage through different patient and/or lesion stratifications. RESULTS: Recanalization was accomplished without assisting devices, and primary stenting was always performed. The technical success of the endovascular treatment reached 91%. Patients experienced 4.2% major morbidity and 2.1% mortality rate. Mean ankle-brachial pressure index increased from 0.43 ± 0.12 preoperatively to 0.89 ± 0.11 postoperatively. A median improvement by 3 Rutherford clinical categories was recorded at the first-month follow-up. The estimated limb salvage rate for patients suffering from critical limb ischemia (CLI) was 90.9% at 36 months. Kaplan-Meier analysis estimation for overall primary and secondary patency rate of the treated lesions was 91.4% and 95.3%, respectively at 36 months. There were no statistically significant differences in primary and secondary patency rate between patients in different clinical stages (CLI versus intermittent claudication), as well as between CTO lesions of different Trans-Atlantic Inter-Society Consensus (TASC) categories (TASC B versus TASC C versus TASC D). There was not statistical significant difference between the technical success of TASC B, C, and D lesion groups. CONCLUSIONS: The endovascular treatment of iliac CTOs seems to be safe and feasible. The technical success of the procedure could be high, whereas primary and secondary patency rates seem to be optimal, with remarkable limb salvage rate and overall clinical improvement. A potential shift to an endovascular-first approach for such lesions might be currently justified.
Authors: Vladimir Cvetic; Dragan Sagic; Igor Koncar; Vladimir Kovacevic; Oliver Radmili; Zelimir Antonic; Borivoje Lukic; Nikola Aleksic; Lazar Davidovic; Djordje Radak Journal: PLoS One Date: 2019-10-02 Impact factor: 3.240