Long-term Clinical Outcomes after Endovascular Treatment by Aortoiliac Artery Stent Implantation

Sep 30, 2026

Long-term clinical outcomes of endovascular therapy for aortoiliac artery lesions were assessed to resolve uncertainty regarding durability and survival after aortoiliac stent implantation. A multicenter retrospective cohort analyzed 1919 patients (2375 limbs) with symptomatic peripheral artery disease treated between 2005 and 2010. Primary patency and mortality were evaluated over extended follow-up, with key predictors identified for patency loss and death.

LanguageEnglish

CategoryHealthcare

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The official journal of the Japan Atherosclerosis Society and the Asian Pacific Society of Atherosclerosis and Vascular Diseases Original Article J Atheroscler Thromb, 2026; 33: 89-98. [http://doi.org/10.5551/jat.65290](http://doi.org/10.5551/jat.65290) Long-term Clinical Outcomes after Endovascular Treatment by Aortoiliac Artery Stent Implantation Akiko Tanaka 1 , Mitsuyoshi Takahara 2 , Kenji Suzuki 3 , Osamu Iida 4 , Terutoshi Yamaoka 5 and Yoshimitsu Soga 6 on behalf of the REAL-AI Investigators 1 Department of Cardiology, Sendai Kousei Hospital, Miyagi, Japan 2 Department of Laboratory Medicine, Osaka University Graduate School of Medicine, Osaka, Japan 3 Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan 4 Cardiovascular Division, Osaka Police Hospital, Osaka, Japan 5 Department of Vascular Surgery, Matsuyama Red Cross Hospital, Ehime, Japan 6 Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan Aim: The long-term clinical outcomes of endovascular therapy (EVT) for aortoiliac (AI) artery lesions remain unclear. This study aimed to investigate 10-year patency and mortality after AI stent implantation. Methods: This multicenter retrospective study included 1919 patients (2375 limbs) who underwent AI stent implantation to treat symptomatic peripheral artery disease (PAD) between January 2005 and December 2010. The study outcome was primary patency, which was defined as a treated vessel without restenosis, mortality, and associated factors. Results: The mean age of the study cohort was 71 ±9 years. Chronic limb-threatening ischemia (CLTI) accounted for 17.2% of cases, and chronic total occlusion (CTO) was found in 24.6% of cases. During a median follow-up period of 2.9 years (interquartile range: 1.0–6.0 years), 412 patients lost patency, whereas 467 patients died without experiencing loss of patency. At 1, 6, and 10 years post-EVT, respectively, the primary patency rates were estimated to be 92.8%, 79.3%, and 77.2%, and the survival rates were 94.9%, 77.0%, and 63. 1% . Female sex, CTO, and the presence of outflow lesions were significantly associated with an increased risk of patency loss after stent implantation (all P＜ 0.05), whereas age, dialysis-dependent renal failure, heart failure, and CLTI were significantly associated with an increased risk of mortality. Conclusion: Stent implantation for AI lesions achieved favorable 10-year patency, with patency loss plateauing after six years. No AI lesion characteristic was associated with mortality. These results support the long-term efficacy of EVT in the clinical practice. Key words: Endovascular therapy, Aortoiliac artery, Peripheral artery disease, Long-term Abbreviation list: EVT, endovascular therapy, AI, aortoiliac, PAD, peripheral artery disease, CLTI, chronic limb-threatening ischemia, CTO, chronic total occlusion, CI, confidence interval, FP, femoropopliteal, ABI, ankle-brachial index | Introduction
The number of patients with peripheral artery disease (PAD) is increasing, especially among the aging population 1-3), and these patients have a poor | prognosis and a high risk of cardiovascular events 4-7) . Endovascular therapy (EVT) with stent implantation for aortoiliac (AI) lesions has become a widely accepted first-line treatment for patients with symptomatic PAD 4, 5) . In comparison to surgical | | --- | --- | Address for correspondence: Akiko Tanaka, Postal_Address; Division of Cardiovascular Medicine, Sendai Kousei Hospital, 1-20, Tsutsumidouri Amamiyamachi, Aoba-ku, Sendai, Miyagi, 981-0914, Japan E-mail Address: [akihende@yahoo.co.jp](akihende@yahoo.co.jp) [Received: June 27](Received: June 27) , 2024 Accepted for publication: June 8, 2025 Copyright©2026 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License. revascularization, EVT offers a less invasive approach wi

FAQs

What was the study’s main goal regarding aortoiliac stent implantation?

To determine 10-year primary patency and mortality after aortoiliac stent implantation for symptomatic peripheral artery disease.

Who were included in the study and how was it conducted?

A multicenter retrospective study included 1919 patients (2375 limbs) treated for symptomatic peripheral artery disease with aortoiliac stent implantation between January 2005 and December 2010.

Which factors were associated with higher risk of patency loss and mortality?

Female sex, chronic total occlusion, and outflow lesions increased the risk of patency loss, while age, dialysis-dependent renal failure, heart failure, and chronic limb-threatening ischemia were associated with increased mortality risk.

Sep 30, 2026

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