Endovascular revascularization for aortoiliac atherosclerotic disease

Figures & data

Table 1 Major studies of currently available iliac artery stents

Study	Stent name	Stent type	Number of patients; number of lesions	Target lesion length	Primary patency	TLR, 1 year
Melodie^Citation8	Express LD	Balloon expandable	151 patients; 163 lesions	32.0±21.7 mma	92.1% at 6 months; 87.8% at 2 years
ACTIVE^Citation9	Assurant	Balloon expandable	123 patients; 159 lesions	29.4±14.7 mma	99.2% at 9 months
Mobility^Citation11	Omnilink	Balloon expandable	123 stent; 121 PTA	45 mm stent; 44 mm PTA	68% stent; 61% PTA	14% stent; 18% PTA
Krol et al^Citation12	Zilver	Self-expanding	34 stent; 39 PTA	82 mm stent; 65 mm PTA	66% stent; 39% PTA	NR
CRISP-US^Citation14	SMART; Wallstent	Self-expanding	102/118 SMART stent; 101/114 Wallstent	24.7±15.6 mm (SMART stent); 24.5±19.1 mm (Wallstent)a	94.7% at 12 months with SMART stent; 91.1% at 12 months with Wallstent	13% stent; 21% PTA
Mobility^Citation15	Absolute Pro	Self-expanding	134 stent; 72 PTA	70 mm stent; 64 mm PTA	81% stent; 37% PTA	13% stent; 55% PTA
Luminexx^Citation16	Lifestar	Self-expanding	134 patients; 156 lesions	25.7±18.2 mma	94.0% stent	3.73% (at 9 months)
Lammer et al^Citation18	Viabahn	Covered self-expanding	61 lesions	69 mm	91% at 12 months
iCARUS^Citation21	iCAST	Covered balloon expandable	165 patients			2.9% (at 9 months)
COBEST^Citation20	V12; BMS	Covered balloon expandable	62/83 V12; 63/85 BMS			2.4% V12; 15.8% BMS (TVR at 18 months)

Notes:

a Data shown as mean ± standard deviation.

Abbreviations: BMS, bare metal stent; COBEST, Covered Versus Balloon-Expandable Stent Trial; NR, not reported; PTA, percutaneous transluminal angioplasty; TLR, target lesion revascularization; TVR, target vessel revascularization.

Table 2 Commercially available stents for aortoiliac disease, with associated sizing

Stent name	Scaffold material	Introducer sheath sizes (Fr)	Stent diameters (mm)	Stent lengths (mm)
Balloon-expandable stents
Express LD	Stainless steel	6–7	6–10	17–57
Assurant	Cobalt–chromium	6	6–10	20–60
Omnilink elite	Cobalt–chromium	6–7	6–10	12–59
Self-expanding stent
Everflex	Nitinol	6	6–8	20–200
SMART^®	Nitinol	6	6–10	20–100
Zilver	Nitinol	6	5–10	20–140
Absolute Pro	Nitinol	6	6–10	20–100
Lifestar	Nitinol	6	6–10	20–100
Covered stents
Viabahn	Self-expanding	7–12	5–13	25–250
Atrium	Balloon	6–7	5–10	16–59
iCAST™	expandable

Table 3 Advantages and disadvantages of iliac artery stent types

Stent type	Advantages	Disadvantages
Self-expanding	• Highly flexible • May be favored in external iliac artery lesions	• Less predictable deployment than balloon-expandable stents
Balloon–expandable	• Increased radial strength • Predictable placement • May be favored in ostial or calcified lesions	• Less flexible than self-expanding stents
Covered stent	• Excludes plaque/thrombus • May be associated with improved patency for TASC C/D lesions	• Requires a larger sheath size than noncovered stents

Abbreviation: TASC, Trans-Atlantic Intersociety Consensus.

Figure 1 Balloon-expandable stent placement for treatment of bilateral common iliac artery disease.

Notes: (A) The right common iliac artery is occluded near the ostium, with moderate disease of the left common iliac artery origin. (B) The occlusion was crossed antegrade, using a Simmons 1 catheter and a straight–stiff glidewire. (C) Bilateral kissing balloon angioplasty was performed for predilation. (D) Bilateral balloon-expandable stents were placed in the common iliac arteries, with a short self-expanding stent extended into the right external iliac artery.

Figure 2 Self-expanding stent placement for treatment of an occluded external iliac artery.

Notes: (A) The right external iliac artery is occluded, with reconstitution in the distal artery near the origin of the common femoral artery. There is also significant stenosis at the origin of the right internal iliac artery. (B) The occlusion was crossed antegrade. Balloon angioplasty of the internal iliac artery origin was performed to minimize the chance of internal iliac artery occlusion. (C) A self-expanding stent was placed across the external iliac artery. (D) Final angiography demonstrated excellent angiographic result with preservation of the internal iliac artery origin.

Figure 3 Revascularization of aneurysmal common iliac arteries with covered stents.

Notes: (A) The bilateral common iliac arteries demonstrate both significant stenosis and aneurysmal dilatation. (B) The left internal iliac artery was treated with coil embolization, and bilateral covered stent placement resulted in excellent angiographic result and exclusion of the common iliac artery aneurysms.

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