Treatment of an iliac chronic total occlusion (CTO)

angiogram

Challenge

  • 77-year-old female evaluated for right buttock claudication
  • Lower extremity Doppler exam revealed reduced ankle-brachial index (ABI) of 0.55 in the right lower extremity and 0.70 in the left lower extremity
  • CT angiogram showed flush ostial CTO of the right common iliac artery with reconstitution of the proximal common femoral artery
  • 50% stenosis of the left common iliac artery and no femoro-popliteal disease or significant trifurcation vessel disease
  • The occlusion was not well-suited to percutaneous revascularization but the patient declined surgical revascularization
  • Relevant patient history:
    • Spine surgery
    • Severe hypertension with left ventricular hypertrophy
    • Hyperlipidemia

Image: Flush ostial CTO of the right common iliac artery with reconstitution of the proximal common femoral artery
Images courtesy of Barry Weinstock, MD. Used with permission.

angiogram

Procedure

  • The patient underwent angiography confirming flush ostial total occlusion of the right common iliac artery with reconstitution of the proximal right common femoral artery
  • The entire iliac artery was dilated with 5 x 100 mm and 7 x 100 mm angioplasty balloons
  • The ostial right iliac artery was stented with a balloon expandable covered stent graft
  • The remainder of the common iliac artery and the entire external iliac artery were stented with a single 7 x 150 mm GORE® VIABAHN® Endoprosthesis with PROPATEN Bioactive Surface*. Post-dilatation of both stent grafts was performed with a 7 x 100 mm angioplasty balloon.

Image: The entire iliac artery was dilated with 5 x 100 mm and 7 x 100 mm angioplasty balloons
Images courtesy of Barry Weinstock, MD. Used with permission.

angiogram

Result

  • Completion angiography reveals a widely patent right iliac artery with brisk flow and no residual stenosis
  • Although the right hypogastric artery remains occluded, the left hypogastric artery is patent
  • At clinical follow-up, the patient was asymptomatic with no claudication
  • A follow-up Doppler exam revealed improvement in her right leg ABI from 0.55 to 1.0

Image: Post-placement of 7 x 150 mm GORE® VIABAHN® Endoprosthesis and 7 x 59 mm balloon expandable covered stent
Images courtesy of Barry Weinstock, MD. Used with permission.

Case takeaways

  • The use of the GORE® VIABAHN® Endoprosthesis is ideal for treatment of iliac total occlusions, particularly when the hypogastric artery is chronically occluded
  • The flexibility of the GORE® VIABAHN® Endoprosthesis is also well-suited to the non-linear course of the external iliac artery
  • Overall, percutaneous treatment of iliac occlusions with the GORE® VIABAHN® Endoprosthesis is an excellent alternative to surgical revascularization


*PROPATEN Bioactive Surface is synonymous with the CBAS Heparin Surface.

The outcomes and observations reported are based on individual case experience and the patients treated. The steps described here may not be complete, and are not intended to be a replacement for the Instructions for Use or the education, training and professional judgment of Healthcare Providers. Healthcare Providers remain solely responsible for making decisions about patient care and the use of medical technologies.

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