Peripheral Vascular Surgery Society

#21 INTERMEDIATE TERM RESULTS OF DUPLEX SURVEILLANCE FOLLOWING ILIAC ARTERY ANGIOPLASTY AND PRIMARY STENTING.

Michael Novotney, MD, Martin R. Back, MD, Steven Roth, MD, Dan Elkins, Brad L. Johnson, MD, and Dennis F. Bandyk, MD

The University of South Florida College of Medicine, Tampa, FL.

Purpose: The utility of surveillance duplex ultrasonography following iliac artery balloon angioplasty and primary stent placement was compared to conventional indicators of clinical outcome to examine specific modes of failure and maximize endovascular inflow patency rates.

Methods: Sixty-seven patients underwent stenting of 84 iliac systems for claudication (64%), rest pain (13%), tissue loss (19%), or failing lower limb bypass graft (4%). The surveillance algorithm included aortoiliac duplex scanning within 1 month and serial (q 6 mo.) limb pressure measurements (ABIs, toe pressure) and femoral artery waveforms. Iliac systems with a PSV >300 by duplex and/or limb symptomatic or hemodynamic deterioration (SVS/ISCVS criteria) were considered failing and prompted angiography.

Results: During follow-up ranging from 1 to 36 months (mean 12 mo.), primary, primary-assisted, and secondary patency rates for the stented iliac system by life table methods were 81%, 95%, and 98% respectively at 18 months. Primary-assisted iliac system patency was significantly worse in patients having an outflow procedure done with or prior to iliac stenting (83% vs. 100% at 18 mo., p=0.01). Clinical limb improvement by SVS/ISCVS criteria was only 76% initially and 59% at 12 months, however, with 25% of the patients not improved initially requiring a subsequent open outflow procedure. In the absence of clinical indicators, duplex surveillance detected 2 of 5 failing iliac systems and allowed secondary intervention. Restenosis within the stented iliac segment accounted for only half of the failing inflow segments detected.

Conclusion: Duplex surveillance after iliac stenting allows detection of failing inflow segments, facilitates optimal assisted patency of the treated iliac system, and exhibits greatest utility in patients with multilevel occlusive disease.

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Last updated January 1,2000