Abstract
Endovascular therapy is the treatment of choice for type A and the preferred treatment for type B lesions. In selective patients, this type of treatment can be applied in type C and even type D lesions. Ipsilateral femoral, contralateral femoral, and brachial approach and both the intraluminal and subintimal space can be used for successful recanalization. The application of stents has improved the immediate hemodynamic and probably long-term clinical results of iliac percutaneous transluminal angioplasty. However, the superiority of primary or direct stenting over selective stenting has not been proven yet. The choice of stent type depends on lesion morphology and location but otherwise there is insufficient evidence to support the use of a particular stent design. There is insufficient evidence to justify routine use of covered stents. All patients should receive antiaggregant therapy following endovascular recanalization of iliac arteries. There is no consensus regarding prophylaxis with antibiotics in iliac recanalization procedures
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Kannel WB, Skinner JJ, Schwartz MJ, et al. (1970) Intermittent claudication: incidence in the Framingham study. Circulation 41:875–883
Newmann AB, Shemanski L, Manolio TA, et al. (1999) Ankle-arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health Study. Arterioscl Thromb Vasc Biol 19:538–545
Diehm C, Schuster A, Allenberg JA, et al. (2004) High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients. A cross-sectional study. Atherosclerosis 172:195–205
Norgren L, on behalf of the TASC Working Group (2007) The TransAtlantic Inter-Society Consensus (TASC II) document on management of peripheral arterial disease. Eur J Vasc Endovasc Surg 33 (Suppl 1):S1–S70
Mc Lean GK, Cekirge S, Weiss JP, et al. (1994) Stent placement for iliac artery occlusions:modified “wire-loop” technique with use of the gooseneck loop snare. J Vasc Interv Radiol 5:701–703
Jacobs DL, Motaganahalli RL, Cox DE, et al. (2006) True lumen re-entry devices facilitate subintimal angioplasty and stenting of total chronic occlusions: initial report. J Vasc Surg 43:1291–1296
Murphy TP, Marks MJ, Webb MS (1997) Technical note: use of a curved needle for true lumen re-entry during subintimal iliac artery revascularization. J Vasc Interv Radiol 8:633–636
McNamara TO, Fischer JR (1985) Thrombolysis of peripheral arterial and graft occlusions: improved results using high-dose urokinase. AJR 144:769–775
Shortell CK, Ouriel K (1994) Thrombolysis in acute peripheral arterial occlusion: predictors of immediate success. Ann Vasc Surg 8:59
Sapoval MR, Chattelier G, Long AL, et al. (1996) Self-expandable stents for the treatment of iliac artery obstructive lesions: long term success and prognostic factors. AJR 166:1173–1179
Long AL, Sapoval MR, Beyssen BM, et al. (1995) Strecker stent implantation in iliac arteries: patency and predictive factors for long-term success. Radiology 194:739–744
Reyes R, Maynar M, Lopera J, et al. (1997) Treatment of chronic iliac artery occlusion with guidewire recanalization and primary stent placement. J Vasc Interv Radiol 8:1049–1055
Blum U, Gabelmann A, Redecker M, et al. (1993) Percutaneous tecanalization of iliac artery occlusions: results of a prospective study. Radiology 189:536–540
Zana K, Otal P, Fornet B, et al. (2001) In vitro evaluation of a new rotational throbectomy device: the Straub Rotarex catheter. Cardiovasc Interv Radiol 24:319–323
Zeller T, Frank U, Burgelin K, et al. (2002) Long-term results after recanalization of acute and subacute thrombotic occlusions of the infra-aortic arteries and bypass-grafts using a rotational thombectomy device. Rofo 174(12):1559–1565
Murphy KD, Encarcacion CE, Le VA, Palmaz JC (1995) Iliac artery stent placement with the Palmaz stent: follow-up study. J Vasc Interv Radiol 6:312–329
Brewster DC, Waltmann AC, O’Hara PJ, et al. (1979) Femoral arterial pressure measurements during aortography. Circulation 60:120–124
Onal B, Erhan TI, Yucel C, et al. (1998) Primary stenting for complex atherosclerotic plaques in aortic and iliac stenoses. Cardiovasc Interv Radiol 21:386–392
Dyett JF, Watts WG, Ettles DF, et al. (2000) Mechanical properties of metallic stents: How do these properties influence the choice of stent for specific lesions? Cardiovasc Interv Radiol 23:47–54
Leung DA, Spinosa DJ, Hagspiel KD, et al. (2003) Selection of stents for treating iliac arterial occlusive disease. J Vasc Interv Radiol 14:137–152
Schurmann K, Vorwerk D, Uppenkamp D, et al. (1997) Iliac arteries: plain and heparin-coated Dacron-covered stents compared with non-covered metal stents: an experimental study. Radiology 203:55
Rzucidlo EM, Powell RJ, Zwolak RM, et al. (2003) Early results of stent-grafting to treat diffuse aortoiliac occlusive disease. J Vasc Surg 7:1175–1180
Lammer J, Dake MD, Bleyn J, et al. (2000) Peripheral arterial obstruction: prospective study of treatment with a transluminally placed self-expanding stent-graft. International Trial Study Group. Radiology 217:95–104
Vorwerk D, Gunther RW (2001) Percutaneous interventions for treatment of iliac artery stenoses and occlusions. World J Surg 25:319–327
Hamer OW, Borisch I, Finkenzeller T, et al. (2004) Iliac artery stent placement: clinical experience and short-term follow-up regarding a self-expanding nitinol stent. J Vasc Interv Radiol 15:1231–1238
Balzer JO, Gastinger V, Ritter R, et al. (2006) Percutaneous interventional reconstitution of the iliac arteries: primary and long-term success rate in selected TASC A and D lesions. Eur Radiol 16:124–131
Strecker EP, Boos IL, Hagen B (1996) Flexible tantalum stents for the treatment of iliac artery lesions: long term patency, complications and risk factors. Radiology 199:641–647
Kudo T, Chandra FA, Ahn SS (2005) Long-term outcomes and predictors of iliac angioplasty with selective stenting. J Vasc Surg 42:466–475
Uberoi R, Sarkar B, Coleman J, et al. (2002) Duplex follow up of aorto-iliac stents. Eur J Vasc Endovasc Surg 23(4):331–335
Jacobs TF, Wintersperger BJ, Becker CR (2004) MDCT-imaging of peripheral arterial disease. Semin Ultrasound CT MR 25(2):145–155
Maintz D, Kugel H, Schellhammer F, et al. (2001) In vitro evaluation of intravascular stent artifacts in three-dimensional MR angiography. Invest Radiol 36:218–224
Schurmann K, Mahnken A, Meyer J, et al. (2002) Long-term results 10 years after iliac artery stent placement. Radiology 224:731–738
Di Mario C, Marsico F, Adamian M, et al. (2000) New recipes for in-stent restenosis: Cut, grade, roast, or sandwich the neointima? Heart 84:471–475
Ettles DF, MacDonald AW, Burgess AA, et al. (1998) Directional atherectomy in iliac stent failure: clinical technique and histopathologic correlation. Cardiovasc Interv Radiol 21:475–480
Kawamata H, Kumazaki T, Tajima H, Niggemann P (2002) Peripheral directional atherectomy evaluated with a rotational digital angiography system. J Nippon Med Sch 67(5):335–341
Tsetis D, Morgan R, Belli AM (2006) Cutting balloons for the treatment of vascular stenoses. Eur Radiol 16:1675–1683
van Andel GJ, van Erp WF, Krepel VM, et al. (1985) Percutaneous transluminal dilatation of the iliac artery: long-term results. Radiology 156:321–324
Blankensteijn JD, van Broonhoven TJ, Lampmann L (1986) Role of percutaneous transluminal angioplasty in aorto-iliac reconstruction. J Cardiovasc Surg 27:466–468
Jeans WD, Amstrong S, Cole SEA, et al. (1990) Fate of patients undergoing transluminal angioplasty for lower-limb ischemia. Radiology 177:559–564
Tegtmeyer CJ, Hartwell GD, Selby JB, et al. (1991) Results and complications of angioplasty in aortoiliac disease. Circulation 83 (Suppl I):I-53–I-60
Jorgensen B, Skovgaard N, Norgard J, et al. (1992) Percutaneous transluminal angioplasty in 226 iliac artery stenoses: role of the superficial femoral artery for clinical success. Vasa 21:382–386
Johnston KW (1993) Iliac arteries: reanalysis of results of balloon angioplasty. Radiology 186:207–212
Rholl KS (1997) Percutaneous aortoiliac intervention in vascular disease In: Baum S, Pentecost MJ (eds) Abram’s angiography: Vol III. Interventional radiology. Little, Brown, Boston, pp 225–261
Becker GJ, Katzen BT, Dake MD (1989) Non-coronary angioplasty. Radiology 170:921–940
Johnston KW, Rae M, Hogg-Johnston SA, et al. (1987) Five-year results of a prospective study of percutaneous transluminal angioplasty. Ann Surg 206:403–413
Colapinto RF, Stronell RD, Johnston WK (1986) Transluminal angioplasty of complete iliac obstructions. AJR 146:859–862
Hausegger KA, Lammer J, Klein GE, et al. (1991) Percutaneous recanalization of pelvic artery occlusions: fibrinolysis, PTA, stents. Rofo 155:550–555
Gupta AK, Ravimandalam K, Rao VR, et al. (1993) Total occlusion of iliac arteries: results of balloon angioplasty. Cardiovasc Interv Radiol 16:165–177
Palmaz JC, Laborde JC, Rivera FJ, et al. (1992) Stenting of iliac arteries with the Palmaz stent: experience from a multicentric trial. Cardiovasc Interv Radiol 15:291–297
Vorwerk D, Gunther RW (1992) Stent placement in iliac arterial lesions: three years of clinical experience with the Wallstent. Cardiovasc Intervent Radiol 15:285–290
Strecker EP, Hagen P, Liermann D, et al. (1993) Iliac and femoropopliteal vascular occlusive disease treated with flexible tantalum stents. Cardiovasc Interv Radiol 16:158–164
Wolf YG, Schatz RA, Knowles HJ, et al. (1993) Initial experience with the Palmaz stent for aortoiliac stenoses. Ann Vasc Surg 7:254–261
Martin EC, Katzen BT, Benenati JF, et al. (1995) Multicenter trial of the Wallstent in iliac and femoral arteries. J Vasc Interv Radiol 6:843–849
Vorwerk D, Guenther R, Schurmann K, et al. (1996) Aortic and iliac stenoses: follow-up results of stent placement after insufficient balloon angioplasty in 118 cases. Radiology 198:45–48
Murphy TP, Webb MS, Lambiase RE, et al. (1996) Percutaneous revascularization of complex iliac artery stenoses and occlusions with use of Wallstent: three-year experience. J Vasc Interv Radiol 7:21–27
Tetteroo E, van der Graaf Y, Bosch JL, et al. (1998) Randomised comparison of primary stent placement versus primary angioplasty followed by selective stent placement in patients with iliac-artery occlusive disease. The Dutch Iliac Stent Trial Study Group. Lancet 351:1153–1159
Treiman GS, Schneider PA, Lawrence PF, et al. (1998) Does stent placement improve the results of ineffective or complicated iliac artery angioplasty? J Vasc Surg 28:104–112
Hassen -Khodja R, Sala F, Declemy S, et al. (2001) Value of stent placement during percutaneous transluminal angioplasty of the iliac arteries. J Cardiovasc Surg (Torino) 42:369–374
Vorwerk D, Guenther R, Schurmann K, et al. (1995) Primary stent placement for chronic iliac artery occlusions: follow-up results in 103 patients. Radiology 194:745–749
Dyett JF, Gaines PA, Nicholson AA, Cleveland T, et al. (1997) Treatment of chronic iliac artery occlusions by means of endovascular stent placement. J Vasc Interv Radiol 8:394–353
Henry M, Amor M, Ethevenot G, et al. (1998) Percutaneous treatment of iliac occlusions: long-term follow-up in 105 patients. J Endovasc Surg 5:228–235
Ballard JL, Bergan JJ, Singh P, et al. (1998) Aortoiliac stent deployment versus surgical reconstruction: analysis of outcome and cost. J Vasc Surg 28:94–101
Scheinert D, Schroder M, Ludwig J, et al. (2001) Stent-supported recanalization of chronic iliac occlusions. Am J Med 110:708–715
Uher P, Nyman U, Lindh M, et al. (2002) Long-term results for stenting chronic iliac occlusions. J Endovasc Ther 9:67–75
Funovics MA, Lackner B, Cejna M, et al. (2002) Predictors of long-term results after treatment of iliac artery obliteration by transluminal angioplasty and stent placement. Cardiovasc Interv Radiol 25:397–402
Carnevale FC, De Blas M, Merino S, et al. (2004) Percutaneous endovascular treatment of chronic iliac artery occlusion. Cardiovasc Interv Radiol 27:447–452
Murphy TP, Ariatnam NS, Carney WI, et al. (2004) Aortoiliac insufficiency: long-term experience with stent placement for treatment. Radiology 231:243–249
Bosch JL, Hunink MGM (1997) Meta-analysis of the results of percutaneous transluminal angioplasty and stent placement for aortoiliac occlusive disease. Radiology 204:87–96
Richter GM, Roeren T, Brado M, et al. (1995) Arterial stenting: randomized trial between primary iliac stenting vs PTA in iliac artery stenosis abd obstruction. Eur Radiol 5:103
Klein WM, van der Graaf Y, Seegers J, et al. (2004) Long-term cardiovascular morbidity, mortality, and reintervention after endovascular treatment in patients with iliac artery disease. The Dutch Iliac Study. Radiology 232:491–498
Powell RJ, Fillinger M, Walsh DB, et al. (2000) Predicting outcome of angioplasty and selective stenting of multisegment iliac artery occlusive disease. J Vasc Surg 32:564–569
Lee ES, Steenson CC, Trimble KE, et al. (2000) Comparing patency rates between external iliac and common iliac artery stents. J Vasc Surg 31:889–894
Timaran CH, Stevens SL, Freeman MB, et al. (2001) External iliac and common iliac artery angioplasty and stenting in men and women. J Vasc Surg 34:440–446
Ponec D, Jaff MR, Swischuk J, et al. (2004) The Nitinol Smart stent vs Wallstent for suboptimal iliac artery angioplasty: CRISP-US Trial results. J Vasc Interv Radiol 15:911–918
Rholl K, Van Breda A (1994) Percutaneous intervention for aortoiliac disease. In: Strandness E, Van Breda A (eds) Vascular diseases. Churchill Livingstone, New York, pp 433–466
Murphy TP, Khwaja AA, Webb MS (1998) Aortoiliac stent placement in patients treated for intermittent claudication. J Vasc Interv Radiol 9:421–428
TransAtlantic Inter-Society Consensus Working Group (2000) Management of peripheral arterial disease. J Vasc Surg 31:97–121
Weinberg DJ, Cronin DW, Baker AG (1996) Infected iliac pseudoaneurysm after uncomplicated percutaneous balloon angioplasty and Palmaz stent insertion: a case report and literature review. J Vasc Surg 162–166
McIntyre KE, Walser E, Hagman J, et al. (1997) Mycotic aneurysm of the common iliac artery and distal aorta following stent placement. Vasc Surg 31:551–557
Hoffman AI, Murphy TP (1997) Septic arteritis causing iliac artery rupture and aneurismal transformation of the distal aorta after iliac stent placement. J Vasc Interv Radiol 8:215–219
Bunt TJ, Gill HK, Smith DC, et al. (1997) Infection of a chronically implanted iliac artery stent. Ann Vasc Surg 11:529–532
Paget DS, Bukhari RH, Zayyat EJ, et al. (1999) Infectability of endovascular stents following antibiotic prophylaxis or after arterial wall incorporation. Am J Surg 178:219–224
Sacks D, Marinelli DL, Martin LG, et al. (2003) Reporting standards for clinical evaluation of new peripheral arterial revascularization devices. J Vasc Interv Radiol 14:S395–S404
Rutherford RB, Baker JD, Ernst CB, et al. (1997) Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 26:517–538
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Tsetis, D., Uberoi, R. Quality Improvement Guidelines for Endovascular Treatment of Iliac Artery Occlusive Disease. Cardiovasc Intervent Radiol 31, 238–245 (2008). https://doi.org/10.1007/s00270-007-9095-5
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DOI: https://doi.org/10.1007/s00270-007-9095-5