PURPOSE: To test the hypothesis that unilateral dilation of a common (CIA) or internal iliac artery (IIA) stenosis in selected patients with contralateral chronic iliac artery occlusion is adequate to offer clinical benefit to the untreated chronically occluded limb.METHODS: Sixteen patients (11 men; mean age 66.7±4.9 years) with chronic occlusion of one CIA [with or without extension to the external iliac artery (EIA)] and CIA stenosis (n=11), IIA stenosis (n=3), CIA and IIA stenoses (n=1), or IIA and EIA stenoses (n=1) on the contralateral side were treated with unilateral angioplasty/stenting of the iliac artery stenosis as sole treatment for both limbs. Clinical and hemodynamic success of this approach was assessed for both limbs.RESULTS: Eleven patients were treated with stenting of the stenosed CIA, 2 with IIA dilation, one with IIA stenting, one with stenting of both the CIA and IIA, and the last with IIA and EIA stenting. Technical success was obtained in all. Immediate hemodynamic success was also 100% for both limbs: the mean resting ankle-brachial index increased from 0.67±0.06 to 0.88 ± 0.04 on the stenosis side and from to 0.53±0.06 to 0.69±0.07 in the contralateral occluded limb (p<0.001). Clinical success was 100% for the treated limb immediately after the procedure and 93.8% for the contralateral limb. One patient with ischemic rest pain in the occluded limb continued to experience severe symptoms after contralateral CIA stenting despite hemodynamic improvement; he had a femorofemoral graft implanted 2 months after the initial intervention and was considered the only clinical failure. During a mean 24-month follow-up (range 12-54), all stented arteries remained patent.CONCLUSION: In selected patients with CIA or IIA stenosis and long chronic occlusion of the contralateral iliac axis, unilateral dilation/stenting of the stenosis alone increases blood flow and improves clinical symptoms to both limbs.
Aged Atherosclerosis