Pseudostenosis of the External Iliac Artery after Common Iliac Artery Occlusion: 2 Case Reports

Endovascular management of aortoiliac artery occlusive disease with pseudo-stenosis of the external iliac artery

In recent years, endovascular treatment has become the first-line revascularisation method for aortoiliac artery occlusive disease. Rarely, aortoiliac artery occlusive disease may be associated with stenosis of the external iliac artery (EIA) that suggested pseudo-stenosis. We describe a case of aortoiliac artery occlusive disease with EIA stenosis without calcification or atheroma. Stent grafts were inserted from the abdominal aorta to the bilateral common iliac arteries. Pre-operative computed tomography and intravascular ultrasound findings confirmed the absence of calcification or atheroma in both EIA, suggesting that the EIA had developed pseudo-stenosis. Following endovascular treatment, the EIA diameter recovered only with balloon dilation after inflow improvement. Consideration is necessary when placing an easy stent graft in the narrow EIA during endovascular treatment for aortoiliac artery occlusive disease with EIA stenosis to avoid a potential stent graft diameter mismatch.

Analysis of Preoperative CT Scan Can Help Predict Technical Failure of Endovascular Treatment of TASC C-D Aortoiliac Chronic Total Occlusions

BACKGROUND AND AIMS

To evaluate if features of occlusion analyzable on preoperative computed tomography scan could predict risks of technical failure or iliac rupture of endovascular treatment of TransAtlantic InterSociety Consensus C-D aortoiliac chronic total occlusion.

METHODS AND RESULTS

All patients treated by endovascular techniques for a TransAtlantic InterSociety Consensus C-D aortoiliac chronic total occlusion between 2009 and 2016 were included (107 patients, 148 iliac arteries). We evaluated the location of the occlusion and the importance of the arterial calcifications. For this factor, patients were divided into 3 groups: the Black occlusion group with mild or no calcifications, the white occlusion group with moderate no protrusive calcifications, and the white protrusive occlusion group with heavy endoluminal calcifications. Technical failure occurred in 11 iliac arteries and peroperative iliac rupture in 6. The location in the external iliac artery is the most significate risk factor of technical failure in univariate (OR = 9.93; P = 0.0012) and multivariate analysis (OR = 15.26; P = 0.0006). The presence of heavy endoluminal calcifications is a further significate risk factor (OR = 13.88; P = 0.0365). Rupture rate was comparable between the 3 groups.

CONCLUSIONS

Preoperative computed tomography scan can predict risk of technical failure but not of iliac rupture.