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Patency at 15 years favorable for IVUS-guided iliac artery stenting
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Patients who underwent primary stenting guided by IVUS to treat iliac artery lesions had high patency rates up to 15 years after the procedure, according to recent results.
However, life expectancy after treatment was poor, and further study of long-term patency and survival are necessary, researchers wrote in the study.
For the single-center, prospective study, researchers evaluated survival and patency at 5, 10 and 15 years among 455 patients (mean age, 72 years) with peripheral artery disease who underwent IVUS-guided primary stenting from June 1993 to 2013. A total of 507 iliac artery lesions were treated.
Endpoints assessed at 15 years included primary, primary-assisted and secondary patency, survival and freedom from major adverse CV and limb events. Median follow-up was 63 months. Primary patency was defined as target lesion patency during follow-up; primary-assisted patency referred to target lesion patency at the target vessel site in the event of restenosis but without occlusion; and secondary patency referred to target lesion patency after reocclusion.
The initial success rate was 97.2%, with lower rates among patients with lesions of type C or D according to TransAtlantic Inter-Society Consensus II (TASC-II) classification (P = .002). Among successfully treated patients, symptoms improved in all patients with intermittent claudication, with two patients requiring minor amputation and one patient requiring major amputation.
Primary patency rates were 89% at 5 years, 83% at 10 years and 75% at 15 years. Secondary patency rates were 92% at 5 years and 91% at 10 and 15 years. Patency rates did not differ significantly according to TASC-II classification. Results from multivariate analysis indicated that postprocedural mean stent lumen area (HR = 0.96; 95% CI, 0.92-0.99), in-stent thrombosis (HR = 9.06; 95% CI, 3.13-26.24), discontinuation of antiplatelet therapy (HR = 10.98; 95% CI, 3.27-36.88) and the presence of calcified lesions (HR = 2.41; 95% CI, 1.11-5.22) were independently predictive of primary patency at 15 years.
Overall survival rates were 82% at 5 years, 56% at 10 years and 40% at 15 years. Patients were free from MACE in 71% of cases at 5 years, 44% at 10 years and 25% at 15 years, and free from major adverse CV or limb events in 57% of cases at 5 years, 29% at 10 years and 14% at 15 years. The researchers observed a trend toward lower survival rates in patients with type C or D lesions (P = .088), but rates of freedom from MACE or free from major adverse CV or limb events did not differ significantly according to TASC-II category. Age (HR = 1.08; 95% CI, 1.06-1.11), critical limb ischemia (HR = 1.99; 95% CI, 1.15-3.47), diabetes (HR = 1.86; 95% CI, 1.13-2.89), hemodialysis (HR = 3.33; 95% CI, 1.48-7.49) and elevated levels of D-dimer (HR = 1.23; 95% CI, 1.11-1.36) were independently predictive of all-cause mortality at 15 years on multivariate analysis.
“IVUS-guided stenting for the iliac artery had favorable 15-year patency in all TASC categories,” the researchers concluded. “Life expectancy after [endovascular treatment] was poor, but stenting is feasible for patients with PAD.” – by Adam Taliercio
Disclosure: The researchers report no relevant financial disclosures.
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