15 Jahre Langzeitergebnisse nach iliakaler Stentangioplastie
Ackers, Mareen Valerie; Mahnken, Andreas H. (Thesis advisor)
Aachen : Publikationsserver der RWTH Aachen University (2013, 2014)
Dissertation / PhD Thesis
The purpose of this study is to retrospectively evaluate results of iliac stenting in patients with common and external iliac arterial occlusive disease and the course of illness of 110 patients treated between 1988 and 1990. Between 1988 and 1990, 110 patients (mean age 57 years, range 40-73 years) were treated with percutaneous transluminal angioplasty (PTA) and stent placement (Wallstents) in their common iliac and/or external iliac artery. From these 110 patients, 88 were male and 22 were female. 126 lesions were treated with 167 stents. Indications for treatment were stenosis (66) and occlusions (60). Patients were followed up on with measurements of ankle-brachial index, angiography, interviews and standardized questionnaires, and later, duplex ultrasound at regular intervals. Because of the long time and long distances for the patients to travel to the Uniklinikum Aachen, more and more patients were lost to follow up with time. From 2006 to 2007, the approach was made to gain information about the clinical course of those patients, who were lost to follow up. Therefore, the residents information offices were contacted, in order to get to know if the patients were, on the one hand, still alive and on the other hand, still living at their old address. After that, patients who were still alive were interviewed through telephone calls or mail, using standardized questionnaires. Survival and stent patency were assessed using Kaplan Meier method. We started the study with 110 patients. After 15 years, 45 patients were still alive (7 women, 38 men) and 62 patients were dead (15 women, 47 men). Within these 15 years, 3 patients were lost to follow up. All in all, 11 patients were not cooperative. During this period, a stent stenosis or occlusion was encountered in 55 of the 126 lesions treated, measured by angiography and/or duplex ultrasound. 31 patients had undergone bypass surgery on the stent side. The survival rate was 82,2% ± 3,7 (standard error) after 5 years of stent placement, 62,62% ± 4,7 after 10 years of stent placement and 43,93% ±4,8 after 15 years of stent placement (Kaplan-Meier method). The number of patients lost to follow up after 5 years of stent placement was 1 patient (1 from 110 => 0,9%), after 10 years 3 patients were lost to follow up (3 from 110 => 2,7%) and after 15 years 5 patients were lost (5 from 110 => 4,5%). The main causes of death were cardiovascular (20) or vascular (4). They were followed by cancer (20), sepsis (2), apoplexy (2), suicide (1) or others (2). In 11 cases, the cause of death could not be determined. The date of death was known in 60 of the 62 patients that had died. The mean survival time after stent placement of the patients that had died was 7,86 years, range 0,19-18,72 years. Female patients died at a mean age of 67,51 years, range 53,82-78,6 and male patients at a mean age of 68,74 years, range 55,82-87,16. In conclusion long-term patency of iliac arterial stents was moderate. Patients with occlusive iliac artery disease have a high risk of dying from arteriosclerotic diseases.