Can interventional radiology (IR) stent an iliac artery dissection?

Interventional Radiology Treatment of Iliac Artery Dissection

Yes, interventional radiology can effectively stent an iliac artery dissection, particularly flow-limiting dissections and those causing significant symptoms. 1

Indications for Stenting Iliac Dissections

• Stenting is indicated for flow-limiting iliac artery dissections, especially those causing symptoms such as claudication, rest pain, or limb ischemia 1
• Provisional stent placement is specifically indicated for iliac arteries as salvage therapy for flow-limiting dissections that occur after balloon angioplasty 2
• Both chronic atherosclerotic and catheter-induced iliac artery dissections can be effectively treated with endovascular stenting 1

Technical Considerations

• Technical success rates for stenting iliac artery dissections are excellent, with studies reporting 100% technical success in restoring luminal patency 1
• For common iliac artery dissections, primary stenting is effective and has strong evidence support (Level of Evidence: B) 2
• For external iliac artery dissections, stenting is also effective as primary therapy (Level of Evidence: C) 2
• Translesional pressure gradients should be obtained to evaluate the hemodynamic significance of the dissection before intervention 2

Outcomes and Patency

• Endovascular treatment of iliac artery dissections shows high patency rates:
  • 97% primary patency at 12 months
  • 90% primary patency at 24 months 1
• Complete symptom relief is achievable in most patients with catheter-induced dissections 1
• Endovascular treatment has low periprocedural complications, mortality, and morbidity 3

Case-Specific Considerations

• Even complex cases such as spontaneous iliac artery dissections extending retrogradely can be successfully treated with stent placement 4
• For young patients (e.g., 38-year-old) with spontaneous iliac dissection causing acute limb ischemia, self-expandable stents have been used successfully 3

Potential Complications and Pitfalls

• Stent occlusion can occur during follow-up (reported in approximately 10% of cases over 24 months) 1
• Careful assessment of outflow vessels is important as poor tibial runoff can decrease durability of the intervention 2
• Female gender and hormone replacement therapy have been reported to decrease patency of iliac stents 2
• Endovascular intervention is not indicated if there is no significant pressure gradient across the dissection despite flow augmentation with vasodilators 2

Treatment Algorithm

1. Confirm hemodynamic significance of the dissection using translesional pressure gradients 2
2. For flow-limiting dissections in the common iliac artery, primary stenting is the preferred approach 2
3. For external iliac artery dissections, stenting is also effective 2
4. Self-expandable or balloon-expandable stents can be used based on the anatomy and location of the dissection 3
5. Post-stenting, patients should receive appropriate antiplatelet therapy 2
6. Regular follow-up imaging is recommended to monitor stent patency 1

Interventional radiology treatment of iliac artery dissections represents a minimally invasive approach with high technical success rates and good clinical outcomes, making it the preferred first-line treatment for most symptomatic iliac artery dissections 1, 3.