Interventional Radiology Treatment of Iliac Artery Dissection
Indications and Technical Considerations
- Provisional stent placement is specifically indicated for iliac arteries as salvage therapy for flow-limiting dissections that occur after balloon angioplasty, as recommended by the American Heart Association 1, 2
- Primary stenting is effective for common iliac artery dissections, with strong evidence support (Level of Evidence: B), according to the American College of Cardiology 3, 4
- For external iliac artery dissections, stenting is also effective as primary therapy (Level of Evidence: C), as stated by the American College of Cardiology 3, 4
- Translesional pressure gradients should be obtained to evaluate the hemodynamic significance of the dissection before intervention, as suggested by the American Heart Association 1, 4
Potential Complications and Pitfalls
- Careful assessment of outflow vessels is important as poor tibial runoff can decrease durability of the intervention, according to the American Heart Association 5
- Female gender and hormone replacement therapy have been reported to decrease patency of iliac stents, as noted by the American Heart Association 5
- Endovascular intervention is not indicated if there is no significant pressure gradient across the dissection despite flow augmentation with vasodilators, as recommended by the American College of Cardiology 4
Treatment Algorithm
- Confirm hemodynamic significance of the dissection using translesional pressure gradients, as suggested by the American Heart Association and the American College of Cardiology 1, 4
- For flow-limiting dissections in the common iliac artery, primary stenting is the preferred approach, according to the American College of Cardiology 3, 4
- Post-stenting, patients should receive appropriate antiplatelet therapy, as recommended by the American College of Radiology 6