Aortoiliac stenting, determinants of clinical outcome

Objectives: to determine predictors of clinical outcome in stenting aortoiliac disease. Design: prospective/retrospective study. Materials and methods: one hundred and forty patients (163 limbs) underwent iliac artery stenting in the period 1994-1997. Ninety-eight occlusions and 65 stenoses were treated, either with primary stenting (n=129) or after failed angioplasty (n=34). Median follow-up 18 months (1-66). Factors analysed for their effect on outcome were: gender, age, Fontaine stage, ABI, lesion type/length/site, primary or secondary stenting, stent type, BP, smoking, diabetes, aspirin, cholesterol, residual gradient, overhanging and run-off. Results: the immediate success was 95%. The primary successful clinical outcome was 90% at 12 months and 84% at 36 months; the primary-assisted successful clinical outcome teas 95% at 12 months and 91% at 36 months and the secondary successful clinical outcome was 92% at 12 months and 87% at 36 months. Adverse factors affecting outcome were: residual pressure gradient (>10 mmHg) and no treatment with aspirin (p<0.05). Major complications occurred in 18% of patients with a re-intervention in 8%. The 30-day mortality was 5.5%. Conclusions: stenting for aortoiliac occlusive disease has good shout and long term clinical success, with low morbidity and mortality. Factors that might improve results further are ensuring that patients are taking aspirin and any residual pressure gradient is abolished.