Remote iliac artery endarterectomy with selective stent use at the proximal dissection zone in TransAtlantic Inter‐Society Consensus C and D lesions

Abstract

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.