Endovascular treatment of internal iliac artery obstructive disease

Background

This study evaluated the therapeutic value of endovascular techniques in patients with buttock claudication caused by stenosis or occlusion of the internal iliac artery.

Methods

The records of patients with buttock claudication who had undergone endovascular treatment for internal iliac artery stenosis or occlusion were analyzed retrospectively, and any associated arterial lesions, morbidity, restenosis, or recurrent buttock claudication was noted. Outcomes were compared with published reports. Iliac artery duplex scans and aortoiliac angiography were performed to detect and confirm the internal iliac artery obstructive disease. The iliac duplex scanning surveillance protocol was set at 3, 6, and 12 months and yearly thereafter to detect eventual restenosis or occlusion.

Results

Between September 2006 and September 2008, 21 consecutive patients (19 men; mean age, 67 years) with 22 cases of buttock claudication (1 bilateral localization) underwent percutaneous transluminal angioplasty alone (14 cases) or additional stent placement in case of elastic recoil (8 cases). Buttock claudication was associated with impotence, thigh claudication, or calf claudication in seven patients. The endovascular approach was successful in all patients, without morbidity or mortality. During a mean follow-up of 14.7 ± 5.7 months, 50% restenosis occurred in one 80-year-old patient. The patient had a pain-free walking distance of 110 meters and was treated conservatively.

Conclusions

To our knowledge, the present study is the largest published report concerning endoluminal treatment of buttock claudication due to internal iliac artery obstructive disease. The midterm results are very encouraging and underscore the value of stent-supported angioplasty as first-line treatment. The procedure can be repeated should significant restenosis occur and does not compromise the option of surgical repair of the lesions.