Acute and Long-Term Outcome of Endovascular Therapy for Aortoiliac Occlusive Lesions Stratified According to the TASC Classification: A Single-Center Experience

Abstract

Purpose:

To compare acute and long-term outcomes of endovascular therapy for TASC (TransAtlantic Inter-Society Consensus) A and B lesions versus TASC C and D lesions.

Methods:

Based on a prospectively maintained database, a retrospective analysis was conducted of 375 symptomatic patients (335 men; mean age 63±8 years) who underwent 438 interventions for aortoiliac arterial obstructions. Lesions were stratified according to the TASC II classification: 259 (59%) procedures involved TASC A/B lesions, while 113 (26%) were for TASC C and 66 (15%) for TASC D lesions.

Results:

The baseline characteristics of patients with TASC A/B lesions differed significantly in the ankle-brachial index (ABI), occurrence of renal insufficiency, and lesion characteristics from those with TASC C or D lesions. Acute treatment success, defined as residual stenosis <30%, was 100%, 96%, 93%, and 100% for TASC A, B, C, and D lesions, respectively. The primary 1-year patency rate, which was 86% for the entire study cohort, was similar for all TASC classifications (89%, 86%, 86%, 85% for TASC A to D lesions, respectively). In the TASC A/B cohort, the 5-year event-free survival (70%) was not significantly better than in the C/D cohort (57%, p=0.124). The clinical outcome, as measured by Rutherford stage and ABI, improved significantly in all TASC subgroups after successful intervention and was maintained up to 1 year. Stenting was an independent predictor for lower restenosis rates (HR 0.517, 95% CI 0.317 to 0.842; p=0.008).

Conclusion:

In experienced hands, endovascular therapy of aortoiliac lesions can be successfully performed with sustained long-term outcome independent of the TASC II classification, even in class D lesions.

Keywords

peripheral artery disease common iliac artery external iliac artery balloon angioplasty stent lesion morphology

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References

Onal

Ilgit

Yucel

. Primary stenting for complex atherosclerotic plaques in aortic and iliac stenoses. Cardiovasc Intervent Radiol. 1998; 21: 386–392.

Norgren

Hiatt

Dormandy

. InterSociety Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007; 45 Suppl S: S5–67.

Park

Kim

. The TransAtlantic InterSociety Consensus (TASC) classification system in iliac arterial stent placement: Long-term patency and clinical limitations. J Vasc Interv Radiol. 2007; 18: 193–201.

Leville

Kashyap

Clair

. Endovascular management of iliac artery occlusions: Extending treatment to TransAtlantic Inter-Society Consensus class C and D patients. J Vasc Surg. 2006; 43: 32–39.

Timaran

Stevens

Freeman

. External iliac and common iliac artery angioplasty and stenting in men and women. J Vasc Surg. 2001; 34: 440–446.

Balzer

Gastinger

Ritter

. Percutaneous interventional reconstruction of the iliac arteries: Primary and long-term success rate in selected TASC C and D lesions. Eur Radiol. 2006; 16: 124–131.

Timaran

Ohki

Gargiulo

. Iliac artery stenting in patients with poor distal runoff: Influence of concomitant infrainguinal arterial reconstruction. J Vasc Surg. 2003; 38: 479–484.

Scheinert

Schroder

Balzer

. Stent-supported reconstruction of the aortoiliac bifurcation with the kissing balloon technique. Circulation. 1999; 100(19 Suppl): II295–300.

Johnston

. Iliac arteries: Reanalysis of results of balloon angioplasty. Radiology. 1993; 186: 207–212.

10.

Scheinert

Schroder

Ludwig

. Stent-supported recanalization of chronic iliac artery occlusions. Am J Med. 2001; 110: 708–715.

11.

Haulon

Mounier-Vehier

Gaxotte

. Percutaneous reconstruction of the aortoiliac bifurcation with the “kissing stents” technique: Long-term follow-up in 106 patients. J Endovasc Ther. 2002; 9: 363–368.

12.

Blum

Gabelmann

Redecker

. Percutaneous recanalization of iliac artery occlusions: Results of a prospective study. Radiology. 1993; 189: 536–540.

13.

Tetteroo

van der Graaf

Bosch

. Randomised comparison of primary stent placement versus primary angioplasty followed by selective stent placement in patients with iliac-artery occlusive disease. Dutch Iliac Stent Trial Study Group. Lancet. 1998; 351: 1153–1159.

14.

Cwikiel

. Restenosis after balloon angioplasty and/or stent insertion — Origin and prevention. Acta Radiol. 2002; 43: 442–454.

15.

Cannon

. Restenosis after angioplasty. N Engl J Med. 2002; 346: 1182–1183.

16.

Kudo

Chandra

Ahn

. Long-term outcomes and predictors of iliac angioplasty with selective stenting. J Vasc Surg. 2005; 42: 466–475.

17.

Palmaz

Laborde

Rivera

. Stenting of the iliac arteries with the Palmaz stent: Experience from a multicenter trial. Cardiovasc Intervent Radiol. 1992; 15: 291–297.

18.

Murphy

Encarnacion

. Iliac artery stent placement with the Palmaz stent: Follow-up study. J Vasc Interv Radiol. 1995; 6: 321–329.

19.

Long

Sapoval

Beyssen

. Strecker stent implantation in iliac arteries: Patency and predictive factors for long-term success. Radiology. 1995; 194: 739–744.

20.

Matsi

Manninen

. Complications of lower-limb percutaneous transluminal angioplasty: A prospective analysis of 410 procedures on 295 consecutive patients. Cardiovasc Intervent Radiol. 1998; 21: 361–366.

21.

Schillinger

Diehm

Baumgartner

. TASC II section F on revascularization: Commentary from an interventionist's point of view. J Endovasc Ther. 2007; 14: 734–742.