Pulsus Journal of Surgical Research

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Nitinol stent implantation in chronic limb ischemia secondary to iliac artery narrowing

Author(s): Hammad A*, Modaber AMA and Aliyev V

Background: Lower-extremity peripheral arterial disease is an important manifestation of systemic atherosclerosis that is associated with markedly increased rates of cardiovascular ischemic events and death. To offer a true therapeutic choice, we will need knowledge from clinical trials that define the potential risks and benefits of each treatment. Combinations of exercise, medication, and revascularization therapies have rarely been evaluated in populations of patients with peripheral arterial disease. The most common site of lower-extremity atherosclerosis is the superficial femoral artery, although the biologic basis for this fact is not clear. Narrowing of the iliac artery is a common presentation of systemic atherosclerosis. Nitinol, an alloy of nickel and titanium, is more flexible and more able to recover from being crushed than stainless steel. The recognition that standards of care for patients with peripheral arterial disease could be improved has led to the creation of new care guidelines. Until the completion of such large clinical trials specific to peripheral arterial disease, many fewer data are available for patients with peripheral arterial disease than for patients with coronary artery disease.

Objectives: The aim of the study was to find out the durability of primary implantation of a self-expanding nitinol stent for the treatment of lesions of the iliac artery in patients with chronic limb ischemia.

Patients and methods: This study was a prospective registry that was conducted on patients with peripheral arterial disease underwent percutaneous trans luminal angioplasty. The study assessed the influence of varying outcome criteria on the success rate at 12 months after percutaneous intervention for peripheral arterial disease and suggested a reporting method that can be used in studies that report results of interventions as measured by parameters of daily clinical practice. Comparison and interpretation of results associated with endovascular revascularization for peripheral arterial disease have been hampered by the different outcome criteria that are applied to classify outcomes as successes or failures. The Peripheral Intervention Registry was established for the quality assessment and improvement of current practice by monitoring the outcomes of percutaneous vascular interventions for peripheral arterial disease affecting the lower extremities. Twenty-five patients with chronic limb ischemia were included in the study referred for percutaneous trans luminal angioplasty constituted the population of the study. All patients included in the study were subjected to history taking, examination, complete general and local examination examination and investigations including 12 leads resting ECG, routine laboratory investigations and Duplex-ultrasonography.

Results: Our results showed that 96% of studied group was males while 4% was females with mean of ages 62.6 years. There was highly statistically significant difference between base line data and six months follows up regarding grade of ischemia and duplex. There was highly statistically significant difference between grade of ischemia after six months follows and risk factors.

Conclusion: For patients with claudication, supervised exercise provides a superior improvement in treadmill walking performance compared to both primary aortoiliac stenting and optimal medical care (home walking and cilostazol) over six months. This benefit is associated with an improvement in self-reported walking distance, an increase in HDL and decrease of fibrinogen. Secondary measures of treatment efficacy favored primary stenting, with greater improvements in self-reported physical function.

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