When peripheral arterial disease affects multiple levels of a leg's blood supply, treatment order matters. Interventionalists generally follow an "inflow before outflow" principle, meaning disease in the aortoiliac segment — the aorta and iliac arteries that supply blood into the leg — is typically addressed before treating more distal lesions in the femoropopliteal or tibial arteries. Iliac artery stenting sits at the center of this inflow-first strategy, and understanding why illustrates a broader logic in how PAD is staged and treated.
Why Treat Inflow Lesions First?
Blood flow to the leg is sequential: it must pass through the aorta and iliac arteries before reaching the femoral, popliteal, and tibial vessels further down. If a significant iliac stenosis or occlusion restricts inflow, treating a more distal lesion in isolation may not meaningfully improve symptoms, because the limiting factor remains upstream. Correcting inflow disease first often improves perfusion pressure throughout the limb and can sometimes reduce the apparent severity of, or even the need to treat, more distal lesions.
What Happens During Iliac Artery Stenting?
Access is typically obtained through the femoral artery, sometimes from the contralateral side or via a brachial approach depending on anatomy, and a guidewire is advanced across the iliac lesion under fluoroscopic guidance. The lesion is usually predilated with a balloon before a stent — commonly a balloon-expandable stent for focal, ostial iliac lesions given the higher radial force needed near the aortic bifurcation, or a self-expanding stent for longer or more tortuous segments — is deployed to maintain the vessel's new diameter. Completion angiography confirms adequate flow before the access site is closed.
Understanding Kissing Stents
When disease involves the aortic bifurcation or affects both common iliac arteries near their origin, a technique called "kissing stents" is often used: two stents are placed simultaneously, one in each iliac artery, positioned so their proximal ends sit side by side at or near the aortic bifurcation. This technique is designed to preserve flow into both iliac arteries and avoid compromising one vessel while treating the other, which can happen if a single stent's struts protrude across the origin of the contralateral iliac artery.
Balloon-Expandable vs Self-Expanding: How Operators Choose
The iliac segment differs mechanically from the femoropopliteal segment: it experiences less repetitive flexion and joint-related motion, which is why balloon-expandable stents, prized for high radial force and precise placement, remain commonly used here, particularly for calcified, ostial lesions near the aortic bifurcation. Self-expanding stents are often preferred for longer iliac lesions, tortuous anatomy, or segments extending toward the external iliac artery, where some flexibility is beneficial. The choice depends on lesion location, calcification, and length, assessed by the treating physician.
INVAMED's Atlas Peripheral Stent System
INVAMED's Atlas Peripheral Stent System is a self-expanding laser-cut nitinol stent indicated for iliac artery lesions, among other peripheral applications, following balloon angioplasty. According to manufacturer-reported specifications, the system covers vessel diameters of 5–8 mm and stent lengths from 20–200 mm, with a 6F delivery profile compatible with a 0.035" guidewire and a triaxial shaft designed for controlled pull-back deployment. Details are available on the Atlas Peripheral Stent System product page; as with all INVAMED devices, availability and specific indications vary by country and should be confirmed against the Instructions for Use (IFU). See the peripheral arterial disease device category for related technologies used across the treatment pathway.
Recovery and Follow-Up After Iliac Stenting
Iliac artery stenting is typically performed as an outpatient or short-stay procedure, with recovery centered on access-site care and a period of antiplatelet therapy to reduce the risk of stent thrombosis. Follow-up generally includes duplex ultrasound surveillance to monitor stent patency over time, since restenosis, though not universal, can still occur even with well-selected devices.
How long do iliac stents typically remain patent?
Patency varies by lesion characteristics, stent type, and patient factors, and is generally monitored through duplex ultrasound follow-up rather than assumed. Manufacturer-reported and published outcome data for a specific device should be reviewed with the treating physician when discussing expected durability.
Device availability and regulatory status vary by country. Please contact INVAMED or your authorized local distributor for current regulatory information applicable to your region.