Outcome of iliac percutaneous transluminal angioplasty with and without the use of stents in patients with intermittent claudication

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Abstract
Background: Despite the absence of controlled data supporting endovascular treatment of iliac disease in patients with intermittent claudication (IC), there has been a significant increase in iliac percutaneous transluminal angioplasty (PTA), and in particular iliac stenting, in recent years. The clinical and haemodynamic outcome of iliac PTA, with and without stenting, was assessed in patients with IC. Methods: A prospectively gathered computerized database of iliac PTA (n = 203) and stenting (n = 88), performed between 1 January 1991 and 31 December 1997, was analysed. Results: Occlusive disease was significantly more likely than stenotic disease to be treated by primary stent deployment (19 of 88, 22 per cent) than PTA alone (11 of 203, 5 per cent) (P < 0·01, χ2 test), as were lesions in the common iliac artery (common 69 of 214 (32 per cent) versus external 14 of 65 (22 per cent); P< 0·05, χ2 test). Primary stent placement was associated with a significant increase in morbidity that delayed hospital stay (13 of 88 (15 per cent) versus seven of 203 (3 per cent); P< 0·05, χ2 test). Emergency revascularization was required in four patients who underwent PTA (2 per cent) and two who had stenting (2 per cent) (P not significant). Conclusion: Iliac stenting is associated with a significant increase in morbidity but with no improvement in symptomatic or haemodynamic outcome. These results do not justify the increased expense associated with the routine use of iliac stents.

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