Predictors for adverse outcome after iliac angioplasty and stenting for limb-threatening XXXX .

@entity1 @entity63 @entity75 @entity177 @entity613 @entity158 @entity1011
OBJECTIVE: The role of iliac artery angioplasty and stenting (IAS) for the treatment of limb-threatening @entity63 is not defined. IAS has been used primarily for @entity1 with disabling @entity613 . Because poorer results have been shown in @entity1 with critical @entity63 after iliac artery angioplasty, the purpose of this study was to estimate the influence of risk factors on the outcome of iliac angioplasty and stent placement in @entity1 with limb-threatening @entity63 . METHODS: During a 5-year period (from 1996 to 2001), 85 iliac angioplasty and stent placement procedures (107 stents) were performed in 31 @entity1 and 43 @entity1 with limb-threatening @entity63 . @entity1 with @entity613 were specifically excluded. The criteria prepared by the Ad Hoc Committee on Reporting Standards (Society for Vascular Surgery/International Society for Cardiovascular Surgery) were followed to define the variables. The TransAtlantic InterSociety Consensus classification was used to characterize the type of @entity75 . Both univariate (Kaplan-Meier [KM]) and multivariate analyses (Cox proportional hazards model) were used to determine the association between variables, cumulative patency, limb salvage, and survival. RESULTS: Indications for iliac angioplasty with stenting were @entity158 (56%) and tissue loss (44%). Primary stenting was performed in 36 @entity1 (42%). Stents were placed selectively after iliac angioplasty mainly for residual stenosis or pressure gradient (43%). Overall, primary stent patency rate was 90% at 1 year, 74% at 3 years, and 69% at 5 years. Primary stent patency rate was significantly reduced in @entity1 compared with @entity1 (KM, log-rank test, P <.001). Primary patency rates at 1, 3, and 5 years were 79%, 57%, and 38% for @entity1 and 92%, 88%, and 88% for @entity1 . Primary stent patency rate also was significantly reduced in @entity1 with @entity177 ( @entity1011 level, >1.6 mg/dL; KM, log-rank test, P <.001). Cox regression analysis identified female gender (relative risk, 5.1; 95% CI, 1.8 to 7.9; P =.002) and @entity177 (relative risk, 6.6; 95% CI, 1.6 to 14.2; P =.01) as independent predictors of decreased primary stent patency. No independent predictors for limb salvage and survival were identified. CONCLUSION: @entity1 undergoing iliac angioplasty and stenting for limb-threatening @entity63 have significantly reduced primary stent patency rates and may need additional procedures to obtain satisfactory clinical improvement and limb salvage. @entity1 with @entity177 and critical @entity63 also have reduced primary stent patency rates after IAS. Limb salvage, as shown in this study, is not affected by previous iliac stent failure.
