Outcomes of Self-Expanding Covered Stents for the Treatment of External ILIAC Artery Obstructive Disease

Purpose To describe the early results and mid-term patency rates of external iliac artery (EIA) stenting using self-expanding covered stents. Methods We conducted a multicenter retrospective study (2015-2021), including patients receiving primary endovascular treatment of external iliac artery occlusive disease with self-expanding covered stents. All patients were treated with the Viabahn (W.L Gore & Associates, Inc., Flagstaff, AZ-USA) stent. Patency and limb salvage rates were estimated with Kaplan-Meier curves. Results Ninety-three patients (mean age, 69 +/- 9 years; 81% males) were treated for disabling claudication in 44%, rest pain in 28%, and tissue loss in 28%. TASC C/D lesions were present in 72% and iliac complete occlusion in 30%. Mean lesion length was 6.9 +/- 2.4 cm; 30% had moderate/severe EIA calcifications; and the mean iliac tortuosity index was 1.17 +/- 0.13. Technical success was 100%. There was one perioperative death (1.4%) and procedural complication rate was 6.5%. At 42 months (mean, 25 months), primary patency was 89.8% (95%CI 83-98); the presence of EIA tortuosity (tortuosity index > 1.25, 87.7 +/- 11% vs 89.9 +/- 8%; P = .6) or severe calcifications (87.6 +/- 9% vs 96.0 +/- 8%; P = .400) had no significant impact. After univariate analysis, the use of a stent with diameter < 8 mm (HR 8.5, 95%CI 3.24-14.22; P < .001) was negatively associated with primary patency. Conclusions The use of self-expanding covered stents provided excellent early and mid-term results in the treatment of obstructive disease of the EIA, also in cases of high EIA tortuosity and high grade of calcifications. The use of a < 8 mm-diameter stent was associated with a reduced primary patency.

Automated summary

This study aimed to evaluate the results of early and mid-term patency rates of external iliac artery (EIA) stenting using self-expanding covered stents. The results showed that self-expanding covered stents provided excellent outcomes in the treatment of obstructive EIA disease, even in cases of high tortuosity and calcifications. However, the use of stents with a diameter less than 8 mm was associated with reduced patency rates.