A total of 104 patients underwent surgical or endovascular surgery (percutaneous transluminal angioplasty: PTA or atherectomy: ATE) between November 1989 and May 1997. In the bypass group, early patency was 96.7%. Actuarial patency for the bypass group was 90.7% at 2 years, 88.1% at 4 years, and 83.2% at 6 years. For iliac lesions, it was 89.6% at 2 years, 85.9% at 4 and 6 years, and for femoral lesions, it was 94.1% at 2 and 4 years, and 80.1% at 6 years. In the PTA group, the early success rate was 76.2%. At 2 years, patency was 23.8%. For iliac lesions it was 30.6% at 2 years, and for femoral lesions, it was 15.6% at 2 years. In the ATE group, the early success rate was 95.0%. At 2 years, patency was 48.9% and at 4 years, it was 39.1%. For iliac lesions, it was 50.0% at 2 and 4 years, and for femoral lesions, it was 49.0% at 2 years and 36.7% at 4 years. Early patency for the bypass group was significantly better than the early success rate for the PTA group. Long term patency for the bypass group was significantly better than for other group. In early results and long term patency, there were almost no differences between the PTA group and the ATE group. In conclusion, bypass shows superior results in comparison with PTA and atherectomy in patients with chronic occlusion of the iliac and the femoral arteries.

We determined cross sectional area of stent and lumen of iliac arterial lesions before and after deployment of Palmaz stents using intravascular ultrasound (IVUS). Stent deployment was performed in 43 patients with 47 lesions. Cross sectional images were recorded using IVUS in the proximal (P), center (C), and distal portion (D) of the stent in the iliac lesions before, immediately after, and 6 months after the deployment of stent. The initial success rate was 100%. Ultrasound images were analyzed for lumen, intra-stent and intimal proliferation area.The lumen area dilated significantly from 9.9±7.1mm² to 32.7±9.4 after the stent deployment. The intra-stent cross sectional area right after the treatment did not show any difference among the 3 portions. The mean stent area after 6 months was 32.8±8.4mm², without significant stent recoil. The lumen (=intra-stent) area after stent deployment were P: 338±9.7mm², C: 30.9±9.0, and D: 32.7±8.6. The lumen of the center portion had a tendency to be smaller than that of the proximal or distal portions. After 6 months, the intra-stent area was P: 33.5±9.2mm², C: 31.5±7.7, and D: 33.3±8.3 and the lumen area was P: 31.3±10.4mm², C: 28.2±8.9, and D: 29.4±10.5. Stent recoil was not observed but minimal dilatation was noted in the center and distal portions. The lumen area after 6 months became smaller than that immediately after the treatments due to intimal proliferation and stent deformation. The lumen area in the center portion had a tendency to be smaller than that of the proximal portion. The rates of change in the lumen area were P: -6.7±5.6%, C: -98±6.4% and D: -12.4±9.9. This showed a tendency for the lumen of the distal portion to be smaller than that of the proximal portion due to intimal proliferation. The intimal proliferation rates showed a tendency to be higher toward distal sites, but the narrowest portion in the stent was its center. The long-term patency diagnosed by angiography was 92.3% in 6 months and 89.5% in 12 and 24 months. IVUS is useful for evaluation of iliac stent deployment. The Palmaz stent was a very effective treatment for the iliac arterial lesions, protecting against vascular recoil.