Sage Journals: Discover world-class research

Abstract

Objective

Hypogastric coverage may be required for occlusive disease at the iliac arterial bifurcation. In this study, we sought to determine patency rates of common-external iliac artery (C-EIA) bare metal stents (BMS) spanning the hypogastric origin in patients with aortoiliac occlusive disease (AIOD). In addition, we sought to identify predictors of C-EIA BMS patency loss and major adverse limb events (MALE) in patients requiring hypogastric coverage. We hypothesized that worsening stenosis of the hypogastric origin would negatively influence C-EIA stent patency and freedom from MALE.

Methods

This is a single center, retrospective review of consecutive patients undergoing elective, endovascular treatment of aortoiliac disease (AIOD) between 2010 and 2018. Only patients with C-EIA BMS coverage of a patent IIA origin were included in the study. Hypogastric luminal diameter was determined from preoperative CT angiography. Analysis was performed using Kaplan–Meier survival analysis, univariable and multivariable logistic regression, and receiver operator characteristics (ROC).

Results

There were 236 patients (318 limbs) who were included in the study. AIOD was TASC C/D in 236/318 (74.2%) of cases. C-EIA stent primary patency was 86.5% (95% confidence interval: 81.1, 91.9) at 2 years and 79.7% (72.8, 86.7) at 4 years. Freedom from ipsilateral MALE was 77.0% (71.1, 82.9) at 2 years and 68.7% (61.3, 76.2) at 4 years. Luminal diameter of the hypogastric origin was most strongly associated with loss of C-EIA BMS primary patency in multivariable analysis (hazard ratio: 0.81, p = .02). Insulin-dependent diabetes, Rutherford’s class IV or above, and stenosis of the hypogastric origin were significantly predictive of MALE in both univariable and multivariable analyses. In ROC analysis, luminal diameter of the hypogastric origin was superior to chance in prediction of C-EIA primary patency loss and MALE. Hypogastric diameter >4.5 mm had a negative predictive value of 0.94 for C-EIA primary patency loss and 0.83 for MALE.

Conclusions

Patency rates of C-EIA BMS are high. Hypogastric luminal diameter is an important and potentially modifiable predictor of C-EIA BMS patency and MALE in patients with AIOD.

Keywords

Aortoiliac occlusive disease iliac stent internal iliac artery atherosclerosis major adverse limb events

Get full access to this article

View all access options for this article.

References

Vinogradova

Lee

Armstrong

, et al. Patency of the internal iliac artery after placement of common and external iliac artery stents. Ann Vasc Surg 2017; 38: 184–189.

Nakazawa

Yazdani Saami

Finn Aloke

, et al. Pathological findings at bifurcation lesions. J Am Coll Cardiol 2010; 55(16): 1679–1687.

Frangos

Gahtan

Sumpio

. Localization of atherosclerosis: role of hemodynamics. Arch Surg 1999; 134(10): 1142–1149.

Smith

Dash

Driscoll

, et al. Outcomes of hypogastric coverage and occlusion during endovascular treatment of aortoiliac occlusive disease. Ann Vasc Surg 2021; 77: 116–126.

Wang

Guan

Chen

, et al. Validation of bifurcation DEFINITION criteria and comparison of stenting strategies in true left main bifurcation lesions. Sci Rep 2020; 10(1): 10461.

Rutherford

Baker

Ernst

, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 1997; 26(3): 517–538.

Johnston

Rutherford

Tilson

, et al. Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg 1991; 13(3): 452–458.

Norgren

Hiatt

Dormandy

, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg 2007; 33(Suppl 1): S1–S75.

Stoner

Calligaro

Chaer

, et al. Reporting standards of the Society for Vascular Surgery for endovascular treatment of chronic lower extremity peripheral artery disease. J Vasc Surg 2016; 64(1): e1–e21.

10.

Patel

Conte

Cutlip

, et al. Evaluation and treatment of patients with lower extremity peripheral artery disease: consensus definitions from Peripheral Academic Research Consortium (PARC). J Am Coll Cardiol 2015; 65(9): 931–941.

11.

Blanche

Dartigues

Jacqmin-Gadda

. Estimating and comparing time-dependent areas under receiver operating characteristic curves for censored event times with competing risks. Stat Med 2013; 32(30): 5381–5397.

12.

Mwipatayi

Sharma

Daneshmand

, et al. Durability of the balloon-expandable covered versus bare-metal stents in the Covered versus Balloon Expandable Stent Trial (COBEST) for the treatment of aortoiliac occlusive disease. J Vasc Surg 2016; 64(1): 83–94.

13.

Kumakura

Kanai

Araki

, et al. 15-Year patency and life expectancy after primary stenting guided by intravascular ultrasound for iliac artery lesions in peripheral arterial disease. JACC: Cardiovasc Interventions 2015; 8(14): 1893–1901.

14.

Doutel

Pinto

Campos

, et al. Link between deviations from Murray’s law and occurrence of low wall shear stress regions in the left coronary artery. J Theor Biol 2016; 402: 89–99.

15.

Katritsis

Theodorakakos

Pantos

, et al. Flow patterns at stented coronary bifurcations: computational fluid dynamics analysis. Circ Cardiovasc Interv 2012; 5(4): 530–539.

16.

Jenei

Balogh

Szabo

, et al. Wall shear stress in the development of in-stent restenosis revisited. A critical review of clinical data on shear stress after intracoronary stent implantation. Cardiol J 2016; 23(4): 365–373.

17.

Schoenenberger

Urbanek

Toggweiler

, et al. Deviation from Murray’s law is associated with a higher degree of calcification in coronary bifurcations. Atherosclerosis 2012; 221(1): 124–130.

18.

Conway

Modarai

Taylor

, et al. Stent-graft limb deployment in the external iliac artery increases the risk of limb occlusion following endovascular AAA repair. J Endovasc Ther 2012; 19(1): 79–85.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.08 MB

Hypogastric artery luminal diameter predicts common-external iliac stent patency and major adverse limb events in patients with aortoiliac occlusive disease