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Advanced Age and Disease Predict Lack of Satisfaction After Iliac Stent Placement
ROLAND ASSI, MD1, KIRSTYN BROWNSON, MD1, MICHAEL HALL, MD1, PENNY VASILAS, RN2, CASSIUS CHAAR, MD1, ALAN DARDIK, MD, PHD1.
1YALE UNIVERSITY SCHOOL OF MEDICINE, NEW HAVEN, CT, USA, 2VA CONNECTICUT HEALTHCARE SYSTEM, WEST HAVEN, CT, USA.
Objectives: Percutaneous angioplasty and stenting of iliac arteries has supplanted open bypass surgery in the treatment of iliac artery disease. However, despite successful radiologic results, some patients do not benefit clinically and are not satisfied with their treatment. This study seeks to identify factors associated with lack of satisfaction after iliac artery stenting.
Methods: Between January 2008 and July 2012, all patients who underwent endovascular treatment of an iliac artery at our institution were included; hybrid treatments combined with simultaneous open treatments were excluded. A retrospective review of charts was conducted and preoperative, operative and post-operative data was collected. JMP ® 9.0.0 software was used for data analysis.
Results: 62 patients had a total of 91 iliac artery stents placed percutaneously. All patients were male with a mean age of 66.5 ± 8.0 years. 47 (52%) had critical limb ischemia, 42 (46%) had an occluded ipsilateral femoral artery, and 77 (85%) had at least 2-vessel distal runoff. Angiographic success was 100%. Perioperative mortality and non-fatal complications were 3.3% (n=3) and 8.8% (n=8), respectively. The mean follow-up time was 24.5 ± 15.7 months, during which 11 (12%) developed restenosis and 31 (34%) required additional surgical interventions (mean time to intervention 4.3 ± 7.3 months). Symptomatic improvement on the first postoperative visit was 55% (n=50). Lack of satisfaction was correlated with older age (OR 1.09 [1.03 - 1.17], p=0.008), presence of critical limb ischemia (OR 3.03 [1.09 - 8.65], p=0.034), and need for additional surgical intervention (OR 5.614 [1.65 - 17.36], p=0.006).
Conclusion: Despite successful radiological revascularization, older patients who undergo iliac stenting in the setting of critical limb ischemia are less likely to experience symptomatic improvement and more likely to require additional surgical interventions. These patients form a high risk group that need careful planning and follow-up after iliac intervention.
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