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Multivariate Analysis of 319 Iliac Stents Reveals the Strong Impact of Demographic Factors and Lesion Severity on Stent Patency
Amy Roach, BS, Sebastian Larion, MS, Chad Ammar, MD, Colin Brandt, MD, S. Sadie Ahanchi, MD, David Dexter, MD, Jean Panneton, MD.
Eastern Virginia Medical School, Norfolk, VA, USA.
OBJECTIVES:
The aim of our study was to perform a large scale multivariate analysis to identify the demographic, anatomic, or procedural factors that impact primary iliac stent patency.
METHODS:
Iliac stents from 2011- 2013 were retrospectively reviewed. Differences in demographic, anatomical, and procedural characteristics were analyzed by univariate analysis between groups based on primary patency. Variables that were considered significant (p<0.05) were brought forward in the cox regression multivariate analysis.
RESULTS:
224 patients underwent primary iliac artery stenting and a total of 319 limbs were analyzed. Average age was 66 years (range 38 to 93), 53% were male, and 57% were Caucasian. Indication for procedure was 64% claudication, 23% rest pain, and 13% ulcer/gangrene. The cohort included all TASC classifications: 50% TASC A, 25% TASC B, 12% TASC C, and 13% TASC D. The treated anatomic location was isolated EIA 27%, isolated CIA 55%, and combined CIA/EIA 18%. Intervention distal to the iliac arteries was performed in 37% of the cohort. Kaplan Meier (KM) analysis at 1 and 3 years revealed a primary patency of 86%/51%, primary assisted patency 98%/89%, and secondary patency of 99%/90%. For those patients with critical limb ischemia preprocedurally, limb salvage was 88% at one year. Based on KM analysis, primary patency (PP) at 1 year for Caucasian patients was 93% versus non Caucasian 79%, P=.001. PP was 76% in patients <60 years of age, 86% in patients 60-70 years of age, and 97% in patients >70 years of age, with a significant difference in KM analysis between all groups, P<.001. PP was significantly different for those with and without EIA occlusion (P<.001), with one year PP by KM analysis 71% and 86%, respectively. PP was also significantly different for those with and without aortic occlusion, (P=.008), with one year patency of 84% and 87%, respectively. We evaluated five factors on multivariate analysis and three factors were identified to impact primary patency: Caucasian race (HR, .517; 95% confidence interval [CI], .313-.852; P=.01) and older age at the time of procedure (HR, .945; 95% CI, .920-.971; P<.001) positively impacted patency. EIA occlusion (HR, 2.352; 95% CI, 1.294-4.275; P=.005) negatively impacted primary patency.
CONCLUSIONS:
In our experience with a large number of iliac interventions, race, age, and EIA occlusion all impacted primary patency.
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