Treatment of Catheter-Induced Iliac Artery Injuries with Self-Expanding Endografts

Abstract

Purpose: To evaluate the efficacy of fabric-covered endoprostheses for percutaneous repair of traumatic iliac artery lesions. Methods: Among 47 patients treated for catheter-induced iliac artery injuries, 20 (42%) patients (13 men; mean age 58 ± 10 years, range 41–76) presented with acute (n = 7) or subacute (n = 13) lesions considered inappropriate for bare stent implantation (17 dissecting aneurysms, 2 perforations, and 1 traumatic arteriovenous fistula). The self-expanding Cragg EndoPro System I or Passager devices were deployed percutaneously to exclude the defects. Results: Immediate exclusion of the lesion was achieved in all 20 cases; there were no major procedural complications. However, within 24 hours after implantation, fever (n = 11, 55%) and elevations in white blood cell count (n = 10, 50%) and C-reactive protein (n = 13, 65%) were seen in the majority of patients, which prolonged hospitalization in this group (8.4 versus 4.2 days). During a median 21-month follow-up (range 5–31), 2 angiographically documented restenoses at the outlet of the endografts were treated successfully with balloon angioplasty, achieving primary and secondary patency rates of 87% and 100%, respectively. Conclusions: Early model stent-grafts provided a safe and effective endovascular treatment for iliac perforations and large arterial dissections, showing a high mid-term patency rate. However, postimplantation syndrome appears to occur frequently with this type of Dacroncovered nitinol device.