SCAI advises on optimal device use in aortoiliac interventions
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The Society for Cardiovascular Angiography and Interventions released guidelines on selection of devices for aortoiliac arterial interventions.
The guidelines, unveiled at the society’s Scientific Sessions and simultaneously published in Catheterization and Cardiovascular Interventions, reviewed the following device options for aortoiliac artery procedures: percutaneous transluminal angioplasty with uncoated balloons, PTA with specialty balloons, drug-coated balloon angioplasty, balloon-expandable bare-metal stents, self-expanding BMS, balloon-expandable covered stents, self-expanding covered stents, drug-eluting stents and atherectomy.
“The iliac interventions are primarily indicated in symptomatic patients, with a goal of relieving claudication, healing wounds in those with critical limb ischemia or to improve patients’ quality of life,” Dmitriy N. Feldman, MD, FACC, FSCAI, FSVM, director of endovascular service and associate professor of medicine at Weill Cornell Medical College, NewYork-Presbyterian Hospital, an author of the guidelines, said during a presentation. “More recently, aortoiliac procedures have also been used in asymptomatic patients requiring large-bore access for mechanical support devices, for structural interventions like transcatheter aortic valve replacement or for vascular interventions like endovascular aneurysm repair procedures. To address the lack of guidance for clinicians, a SCAI working group has developed guidelines on device selection in aortoiliac interventions.”
The panel reviewed 131 articles to determine the evidence for each device option, providing guidelines with class of recommendation (COR) and level of evidence (LOE) in 11 anatomical criteria.
Recommendation for PTA with uncoated balloons was IIa (moderate) or IIb (weak) across the 11 anatomical categories, Feldman said.
The panel gave COR III (no benefit) to PTA with specialty balloons in any anatomical category due to lack of comparative effectiveness data, he said.
Among BMS, balloon expandable stents received a COR I (strong) recommendation in aortoiliac bifurcation lesions, focal common and diffuse common iliac artery lesions, whereas self-expanding stents received a strong recommendation in diffuse common iliac artery lesions, focal and diffuse external iliac artery lesions, and there were moderate or weak recommendations in all other anatomical categories, Feldman said.
The panel gave a COR III (no benefit) recommendation to DES and DCB devices. “Given the lack of safety and efficacy data addressing the use of DES and DCBs in the aortoiliac segment, the use of these devices should be very limited at this time,” he said.
Balloon expandable covered stents had strong or moderate recommendations in all categories, whereas self-expanding covered stents had moderate or weak recommendations for all categories, Feldman said.
“Endovascular therapy is very effective for patients with lifestyle-limiting claudication and hemodynamically significant aortoiliac disease,” Feldman said. “The 2020 SCAI guidelines document provides comprehensive guidance with specific recommendations (COR and LOE) for 11 different anatomical subsets and examines all major groups of devices when it comes to aortoiliac device selection.”
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