An iliac stent is a small, mesh-like tube used to open a narrowed or blocked segment of an iliac artery. This minimally invasive device is designed to remain permanently in place to restore proper blood flow to the lower extremities. The primary function of the stent is to maintain a clear channel, ensuring oxygen-rich blood reaches the legs and feet, which alleviates symptoms caused by reduced circulation. This placement is a common treatment for vascular disease affecting the large arteries in the pelvic region.
Anatomy of the Iliac Arteries
The iliac arteries are located deep within the pelvic region, serving as the main arterial connection between the upper and lower halves of the body. They originate when the abdominal aorta, the largest artery, divides into two branches near the level of the navel, forming the common iliac arteries. These common iliac arteries then descend briefly before each splits into the internal and external iliac arteries.
The internal iliac artery supplies blood to the organs and tissues within the pelvis, such as the bladder and reproductive organs. The external iliac artery continues its course downward, passing beneath the inguinal ligament in the groin. Once it passes this point, the vessel is renamed the femoral artery, which becomes the main source of blood supply for the entire leg.
Stent placement primarily targets the common iliac artery and the external iliac artery. Blockages in these large vessels directly limit blood flow to the legs, which is the most common reason for intervention. The external iliac artery is a frequent site for the atherosclerotic disease that necessitates stenting.
Conditions Requiring Stent Placement
The need for an iliac stent typically arises from Iliac Artery Occlusive Disease, a specific manifestation of Peripheral Artery Disease (PAD). This involves the narrowing or complete obstruction of the iliac arteries due to atherosclerosis, a progressive disease where plaque builds up within the artery walls.
This accumulation of plaque causes the arterial lumen to narrow, a process known as stenosis, which restricts blood flow. As the blockage worsens, the reduced blood flow to the leg muscles causes claudication. This discomfort is described as cramping, aching, or fatigue in the buttocks, thigh, or calf that occurs during walking and resolves with rest.
In advanced stages, the lack of oxygenated blood can lead to severe symptoms, including pain while resting, called rest pain. When blood flow is severely compromised, it can lead to non-healing wounds, ulcers, and tissue death (gangrene). Stenting aims to address the physical blockage to restore perfusion and prevent these severe outcomes.
Overview of the Iliac Artery Stenting Procedure
Iliac artery stenting is an endovascular procedure performed entirely within the blood vessel using specialized tools. The process begins with the vascular specialist gaining access to the arterial system, usually through a small puncture in the femoral artery located in the groin. This access point allows instruments to be navigated into the diseased iliac artery.
A thin, flexible guidewire is threaded through the artery under continuous X-ray guidance (fluoroscopy), which uses a contrast dye to illuminate the blood vessels. Once the guidewire crosses the narrowed segment, a catheter is advanced over it. The next step involves balloon angioplasty, where a small balloon at the catheter tip is inflated at the site of the blockage.
The inflation of the balloon compresses the plaque against the artery wall, widening the vessel and preparing it for the stent. After the vessel has been adequately opened, the balloon is deflated and removed. A new catheter carrying the collapsed stent is then advanced to the exact location.
The stent itself may be either balloon-expandable (requiring a separate balloon inflation to deploy) or self-expanding (expanding on its own once released from its sheath). The metal mesh tube expands to the artery’s intended diameter, acting as a scaffold to hold the artery open. Once the stent is securely in place, all wires and catheters are removed, and the small puncture site is closed.
Recovery and Long-Term Care
Immediately following the procedure, patients are typically required to remain still and lie flat for several hours to allow the puncture site in the groin to seal completely. Close monitoring of the access site is important to check for any signs of bleeding or swelling. Most individuals remain in the hospital overnight for observation before being discharged.
Long-term care requires the use of antiplatelet medications, such as aspirin or clopidogrel, often prescribed as dual antiplatelet therapy for a short period. These medications inhibit platelets from sticking together, reducing the risk of clotting within the newly placed stent (stent thrombosis). After the initial period, patients are typically maintained on aspirin indefinitely.
To maximize the long-term success of the stent and prevent new blockages in other arteries, significant lifestyle adjustments are necessary. Smoking cessation is the most impactful modification, alongside managing conditions like high blood pressure, diabetes, and high cholesterol. Regular exercise and a heart-healthy diet contribute to better overall vascular health.