Primary stenting guided by intravascular ultrasound (IVUS) for the iliac artery showed favorable 15-year patency and poor life expectancy after endovascular treatment (EVT), according to recent data published in the Journal of the American College of Cardiology: Cardiovascular Interventions.
Treatment methods for peripheral arterial disease (PAD) are generally chosen based on lesion type using morphological stratification from the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC) classification in the aorto-iliac artery. EVT has shown favorable results for iliac artery lesions, but reports of long-term patency are limited.
According to the researchers, IVUS, “gives a high-resolution cross-sectional image for use during coronary and peripheral intervention, and the additional morphological information may decrease the restenosis rate after stent implantation. However, factors evaluated by IVUS that cause restenoisis in long-term patency after EVT have not been analyzed in detail.”
Researchers performed EVT on 507 lesions for 455 patients with PAD to establish a 15-year end point for primary, primary assisted, and secondary patency. All of the stent implantations were guided by IVUS. The researchers calculated the mean value of the proximal, middle, and distal stent areas to establish mean stent lumen area. They also obtained blood samples from participants to measure cholesterol, triglyceride, glucose, and creatinine levels.
The 5, 10, and 15-year primary patencies were 87%, 83%, and 75%, respectively, and the secondary patencies were 92%, 91%, and 91%, respectively. Postprocedural lumen area, in-stent thrombosis, antiplatelet therapy discontinuation, and calcified lesions were predictors of primary patency.
The overall 5, 10, and 15-year survival rates were 82%, 56%, and 40%, respectively. Predictors for overall survival were age, critical limb ischemia, diabetes, hemodialysis, and D-dimer level.
Over the course of follow-up, there was a 34% mortality rate. Causes of death included that cardiovascular disease (49%), malignancy (23%), and pneumonia (20%). Freedom from major adverse cardiac event rates for 5, 10, and 15 years were 71%, 44%, and 25%, respectively.
“These consistent results suggest that severe PAD and complication with diabetes mellitus involve extensive and severe degrees of systemic atherosclerosis that are responsible for the mortality caused by cardiovascular disease,” the authors concluded.
The results showed favorable 15-year patency across all TASC categories after iliac stenting, but the authors note that further research should be conducted to improve drug compliance for patients with PAD who have had EVT.
Kumakura H, Kanai H, Araki Y, et al. Fifteen-year Patency and Life Expectancy after Primary Stenting Guided by Intravascular Ultrasound for Iliac Artery Lesions in Peripheral Arterial Disease. J Am Coll Cardiol Intv. 2015; doi:10.1016/j.jcin.2015.08.020.