Zusammenfassung
Background: Remote iliac artery endarterectomy (RIAE) is a challenging technique in the treatment of arterial occlusive disease. The impact of proximal transection zone stenting on patency rates is still unclear. Methods: This is a retrospective analysis of all patients who underwent RIAE in our hospital between March 2007 and October 2017. A stent was used in cases with a dissection flap or a ...
Zusammenfassung
Background: Remote iliac artery endarterectomy (RIAE) is a challenging technique in the treatment of arterial occlusive disease. The impact of proximal transection zone stenting on patency rates is still unclear. Methods: This is a retrospective analysis of all patients who underwent RIAE in our hospital between March 2007 and October 2017. A stent was used in cases with a dissection flap or a stenosis at the proximal transection zone after RIAE. In all other cases, we did not use a stent. Study end points were patency rates, limb salvage, and survival after 5 years. Results: There were 115 RIAEs performed in 108 patients. All lesions were TransAtlantic Inter-Society Consensus C (61.7%) or D (38.3%) lesions. The median follow-up time was 38.5 months (range, 0-117 months). The indications were claudication in 67.0% and critical limb ischemia in 33.0%. Group 1 (n = 56) included all patients without a stent; group 2 (n = 59) included all patients with stenting of the proximal dissection zone. Risk factors were similar between the groups. The 30-day morbidity and mortality rates between the groups were not significantly different. The primary patency rate was 81.6% (group 1, 76.2%; group 2, 87.6%; P =.286), the primary assisted patency rate was 91.9% (group 1, 94.0%; group 2, 90.0%; P =.512), and the secondary patency rate was 93.8% (group 1, 94.0%; group 2, 91.6%; P =.435) after 5 years. Limb salvage (97.2%; group 1, 100%; group 2, 94.5%; P =.084) and survival time (57.1%; group 1, 66.7%; group 2, 43.5%; P =.170) were also not significantly different between the groups. A restenosis at the transection zone occurred in 14.3% in group 1 and 1.7% in group 2 (P =.013) during follow-up. A newly formed occlusion of the hypogastric artery was seen in 5.2% of patients after RIAE. Conclusions: RIAE is a safe procedure with excellent patency rates. However, the restenosis rate is higher in cases without stenting.
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