Therapeutic approach to the unilateral occlusive iliac artery disease. Preliminary results

BACKGROUND: The different therapeutic approaches to unilateral occlusive iliac artery disease are analyzed. METHODS: In the period from September 1999 to September 2001, a total of 43 patients (38 males and 5 females) has been treated for unilateral iliac artery occlusive disease. Thirty-four cases (79%) underwent an endovascular procedure, and the remaining 9 cases (21%) had a surgical intervention. Endovascular techniques included 11 cases of percutaneous transluminal angioplasty (PTA) of common iliac artery (25.6% of whole series), 5 PTA of external iliac artery (11.6%), 8 PTA+stenting of common iliac artery (18.6%) and 10 PTA+stenting of external iliac artery (23.2%). In 9 cases a surgical revascularization was performed: 6 patients underwent a femoro-femoral cross-over bypass (14%); 2 cases were treated with aorto-bifemoral reconstruction (4.7%) and one patient was operated with ilio-femoral graft (2.3 %). RESULTS: The analysis of the follow-up of our series showed, in the group of 34 patients treated with endovascular procedures, successful results were obtained in 79.4% (27 cases); in the 9 patients operated with surgical revascularization the success rate was 88.9% (8 cases ); failure rate was 20.6% for endovascular procedures and 11.1% for surgical interventions. CONCLUSIONS: The conclusion is drawn that endovascular approach (PTA, stenting) is usually the procedure of choice in the treatment of unilateral well localised lesions of the iliac artery. Conventional surgical intervention is effective for revascularizing an extensive involvement of the iliac segment or in case of bilateral disease.