Endovascular stenting as the first treatment for patients with occluded iliac arteries found to be safe and cost-effective in a study comparing patients with primary stent placement and primary angioplasty followed by selective stent placement.
Endovascular stenting as the first line of treatment for patients with occluded iliac arteries has been shown by more than five years of follow-up to be both safe and cost-effective. This patient population is at high risk of cardiovascular morbidity and mortality, according to study in the August issue of Radiology.
Dr. Willemijn M. Klein and colleagues retrospectively compared 279 patients from the multicenter randomized Dutch Iliac Stent Trial (DIST) who presented with stenosis or occlusion of the iliac arteries.
Patients went into two groups: 143 underwent primary stent placement, and 136 underwent primary angioplasty followed by selective stent placement.
With a mean follow-up period of 5.6 years, the investigators found no statistically significant difference in the number of reinterventions, additional cardiovascular events, or mortality between the two treatment groups.
Eighteen percent of patients in the primary stent placement group and 20% of those in the primary angioplasty group underwent reintervention of their iliac arteries. Another 25% of patients in the primary stent placement group and 30% of those in the primary angioplasty group underwent treatment of the legs ipsilateral to the treated iliac artery.
The risk of other cardiovascular events was 13% for the primary stent group and and 11% for the primary angioplasty group. The risk of death was 15% and 16%, respectively.
Patients' sex (female preponderance), the extent of stenosis, and the presence of critical ischemia helped predict the likelihood of iliac reintervention. Creatinine level and walking distance during the exercise test taken at the time of inclusion in the study helped predict myocardial infarction, stroke, and vascular death.
Percutaneous transluminal angioplasty followed with selective stent placement under DIST guidelines - a 10-mm Hg pressure gradient after angioplasty - was an effective strategy. This led to a 34% drop in the total number of patients requiring a stent under current FDA-approved guidelines, investigators said. DIST results validate previous studies showing that the use of stents only when necessary yields good clinical results.
The study also showed that stent placement does not lead to further intervention at the site of implantation, a finding with potential cost-effectiveness implications. Stent placement is usually regarded not only as a safe treatment, but also easier and faster to perform than angioplasty followed by selective stent placement, researchers said.
The real danger for patients with peripheral artery disease is not amputation but rather cardiovascular complications leading to fatal episodes. Peripheral artery disease should thus be deemed as a marker of potentially dangerous atherosclerotic disease elsewhere in the body that needs to be investigated and treated in every patient, the researchers said.
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