Utility of Duplex Surveillance following Iliac Artery Angioplasty and Primary Stenting

Abstract

Purpose:

To evaluate the clinical outcome and patency rates after iliac artery angioplasty and primary stenting using a noninvasive surveillance protocol that includes duplex ultrasonography.

Methods:

Sixty-seven patients (64 men; mean age 61 ± 9 years, range 45–83) underwent stenting of 84 iliac systems for claudication (63%), rest pain (9%), tissue loss (20%), or failing lower limb bypass graft (8%). The surveillance algorithm included aortoiliac duplex scanning within 1 month and serial limb pressure measurements and femoral artery waveform analyses during follow-up. Iliac systems with a peak systolic velocity >300 cm/s and velocity ratio >2.0 by duplex and/or symptomatic or hemodynamic deterioration were considered failing and an indication for angiography.

Results:

During intermediate-term follow-up ranging to 36 months (mean 12), life table primary, assisted primary, and secondary patency rates for the treated iliac systems were 78%, 90%, and 98%, respectively, at 18 months. Assisted primary iliac system patency at 18 months was significantly worse in the 20 (24%) limbs having an outflow bypass done with or prior to iliac stenting (83% versus 100% without bypass, p = 0.01). Indirect clinical indicators found 17 (20%) suspected failing iliac systems, in which duplex imaging correctly identified 5 of 6 recurrent iliac stenoses and facilitated secondary endovascular intervention. Three (4%) stent occlusions occurred in the treated iliac systems despite surveillance.

Conclusions:

Duplex surveillance after iliac stenting localizes failing inflow segments, optimizes assisted patency of the treated iliac system, and possesses greatest utility in patients with multilevel occlusive disease and outflow reconstructions.