Comparing patient outcomes between multiple ipsilateral iliac artery stents and isolated iliac artery stents

Objective: Endovascular stents are accepted therapy for iliac artery stenoses and occlusions. Surgery is the recommended therapy for patients with severe iliac artery disease, including those with the combination of ipsilateral common iliac artery (CIA) and external iliac artery (EIA) stenoses/occlusions. This study compared patient outcomes, including late open conversion rates, for combined ipsilateral CIA and EIA stenting vs CIA or EIA stents alone. Methods: Between 1998 and 2010, 588 patients underwent iliac artery stenting at two institutions. Patient comorbidities and outcomes were retrospectively reviewed, and analyses were performed using multivariate regression and Kaplan-Meier methods. Results: There were 436 extremities with CIA stents, 195 with EIA stents, and 157 with CIA and EIA stents. The groups did not differ significantly in demographics, comorbidities, or treatment indications. During follow-up, 183 patients died, 95 underwent an endovascular reintervention, and 48 required late open conversion. For patients in the CIA or EIA stent group, the mean +/- standard error survival was 5.3 +/- 0.3 years, secondary endovascular intervention-free survival was 7.4 +/- 0.6 years, late open conversion-free survival was 9.8 +/- 0.4 years, and amputation-free survival was 7.6 +/- 0.4 years. In the CIA and EIA stent group, survival was 6.1 +/- 0.6 years, secondary endovascular intervention-free survival was 7.2 +/- 0.6 years, late open conversion-free survival was 9.0 +/- 1.1 years, and amputation-free survival was 8.4 +/- 0.5 years. Survival, reintervention-free survival, late open conversion-free survival, and amputation-free survival were all similar between patient groups (all P > .05). CIA and EIA stenting in combination was not a predictor of death, reintervention, late open conversion, or amputation. Conclusions: Outcomes are similar for patients with CIA or EIA stents and for those with combined ipsilateral CIA and EIA stents. Late open conversions for iliac artery stent failure are uncommon and not influenced by the location or extent of prior iliac artery stent placement. Endovascular therapy for aortoiliac disease should be extended to consider selected patients with ipsilateral CIA and EIA stenoses/occlusions. (J Vasc Surg 2012; 55: 1637-46.)