Long-term outcome of percutaneous endovascular stenting in external iliac artery endofibrosis

• Published in: Vascular medicine (London, England) England), 2024-06, Vol.29 (3), p.256-264
• Main Authors: Sharifi, Mohsen, Snyder, Robert, Sharifi, Iman, White, Emily
• Format: Article
• Language: English
• Subjects: Adult; Body mass index; Body size; Cardiovascular system; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Female; Fibrosis; Humans; Hypertrophy; Iliac Artery - diagnostic imaging; Iliac Artery - surgery; Implants; Limbs; Male; Medical imaging; Middle Aged; Patients; Peripheral Arterial Disease - diagnostic imaging; Peripheral Arterial Disease - therapy; Recurrence; Retrospective Studies; Signs and symptoms; Stenosis; Stents; Surgery; Time Factors; Treatment Outcome; Ultrasonography, Interventional; Vascular diseases; Vascular Patency
• ISSN: 1358-863X; 1477-0377; 1477-0377
• DOI: 10.1177/1358863X241227476

Background: External iliac artery endofibrosis (EIAE) is a rare vascular disease which has been traditionally seen in avid cyclists. The conventional approach has been surgery, although no high-quality evidence suggests superiority of surgery over percutaneous endovascular intervention. There are limited data on the efficacy of stenting in EIAE. Methods: Over a 14-year period, we treated 10 patients (13 limbs) with EIAE with stents. These patients had declined surgery. The mean follow up was 8.4 ± 3.3 years. There were eight women. Five patients were competitive runners, three were cyclists, and two were triathletes. The mean age was 40.7 ± 2.9 years and body mass index was 19.46 ± 1.6. Intravascular ultrasound (IVUS) was used in eight limbs. Results: Procedural success was achieved in all. The recurrence of symptoms occurred in three patients at a mean of 9.3 ± 2.1 months postindex intervention. The other seven patients remained symptom free. IVUS revealed a pathognomonic finding which we termed ‘perfect circle appearance’. It results from symmetric or asymmetric hypertrophy of one or more layers of the arterial wall leading to negative remodeling, which creates a distinct echo dense structure contrasting itself from the luminal blood’s echoluscent appearance. It is identical to IVUS images of diffuse venous stenosis with important implications in the treatment technique. Conclusions: We conclude that stenting in EIAE is safe and effective with a good long-term outcome. It can be an alternative to surgery, particularly in those patients who refuse a surgical approach. The IVUS image is pathognomonic and ‘sine qua non’ of EIAE.