Endovascular treatment of TransAtlantic Inter-Society Consensus D aortoiliac occlusive disease using unibody bifurcated endografts

Purpose To evaluate the safety and efficacy of transbrachial and transfemoral approaches combined with visceral protection for the endovascular treatment of juxtarenal aortoiliac occlusive disease (AIOD) over an average 19-month follow-up period. Methods In this retrospective analysis, all patients with juxtarenal AIOD at a single institution were reviewed from June 2015 to January 2020. Patient characteristics, angiographic results, and follow-up outcomes were retrospectively recorded. The indications for treatment were critical limb threatening ischemia in 12 patients and bilateral claudication in five patients. Percutaneous access via the left brachial artery was first obtained to recanalize the infrarenal occluded lesions. After that, femoral accesses were achieved. A 4-Fr catheter, a 4 mm balloon, or a 6-Fr 90-cm-long sheath was used to complete visceral artery protection. Results A total of 17 juxtarenal AIOD patients (14 males; mean age, 63.4 ± 8.1 years) underwent endovascular treatment. The technical success rate was 100%. Complete reconstruction was achieved in 15 (88.2%) patients. The infrarenal aorta was reconstructed with kissing covered stent grafts ( n = 7), kissing bare-metal stents ( n = 2), covered stent grafts ( n = 2), bare-metal stents ( n = 1), or the off-label use of iliac limb stent grafts ( n = 5). Renal embolization was found in 3 (17.6%) patients during intraoperative angiography. There was 1 (5.9%) case of distal runoff embolization after CDT and 1 (5.9%) case of left iliac artery rupture. One (5.9%) death occurred due to acute myocardial infarction 20 days after the operation. The average follow-up period was 19.3 ± 16.7 months (range, 1–54 months) in the remaining 16 cases. The renal artery patency rate was 100%. The estimated cumulative primary patency rates were 92.3% at 12 months and 59.3% at 36 months according to the Kaplan–Meier method. Conclusions Transbrachial and transfemoral approaches combined with visceral protection offer a safe and effective alternative to open revascularization for the endovascular treatment of juxtarenal AIOD.

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Outcomes of hypogastric coverage and occlusion during endovascular treatment of aortoiliac occlusive disease

Annals of Vascular Surgery ◽

10.1016/j.avsg.2021.05.020 ◽

2021 ◽

Author(s):

Andrew H. Smith ◽

Siddhartha Dash ◽

Erin C. Driscoll ◽

Levester Kirksey ◽

Jarrad Rowse ◽

...

Keyword(s):

Endovascular Treatment ◽

Occlusive Disease ◽

Aortoiliac Occlusive Disease

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RR27. Effect of Physician and Hospital Experience on Patient Outcomes for Endovascular Treatment of Aortoiliac Occlusive Disease

Journal of Vascular Surgery ◽

10.1016/j.jvs.2010.02.245 ◽

2010 ◽

Vol 51 (6) ◽

pp. 99S

Author(s):

Charles T. Tuggle ◽

Julie A. Sosa ◽

Anant Mandawat ◽

Jeffrey E. Indes

Keyword(s):

Endovascular Treatment ◽

Patient Outcomes ◽

Occlusive Disease ◽

Aortoiliac Occlusive Disease ◽

Hospital Experience

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The Comparison between Axillofemoral Bypass and Endovascular Treatment for Patients with Challenging Aortoiliac Occlusive Disease as Alternative Treatment to Aortofemoral Bypass

Annals of Vascular Diseases ◽

10.3400/avd.oa.20-00004 ◽

2020 ◽

Vol 13 (2) ◽

pp. 144-150

Author(s):

Masato Nishizawa ◽

Kimihiro Igari ◽

Sotaro Katsui ◽

Toshifumi Kudo ◽

Hiroyuki Uetake

Keyword(s):

Endovascular Treatment ◽

Alternative Treatment ◽

Occlusive Disease ◽

Aortofemoral Bypass ◽

Aortoiliac Occlusive Disease ◽

Axillofemoral Bypass

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Outcomes From the Multicenter Italian Registry on Primary Endovascular Treatment of Aortoiliac Occlusive Disease

Journal of Endovascular Therapy ◽

10.1177/1526602819863081 ◽

2019 ◽

Vol 26 (5) ◽

pp. 623-632 ◽

Cited By ~ 5

Author(s):

Gabriele Piffaretti ◽

Aaron Thomas Fargion ◽

Walter Dorigo ◽

Raffaele Pulli ◽

Andrea Gattuso ◽

...

Keyword(s):

Endovascular Treatment ◽

Cox Regression ◽

Limb Ischemia ◽

Primary Patency ◽

Occlusive Disease ◽

Endovascular Intervention ◽

Chronic Obstructive ◽

Secondary Patency ◽

Aortoiliac Occlusive Disease ◽

Cox Regression Analysis

Purpose: To report the results of endovascular treatment of iliac and complex aortoiliac occlusive disease (AIOD) in a multicenter Italian registry. Materials and Methods: A retrospective, multicenter, observational cohort study analyzed 713 patients (mean age 68±10 years; 539 men) with isolated iliac and complex aortoiliac lesions treated with primary stenting between January 2015 and December 2017. Indications for treatment were claudication in 406 (57%) patients and critical limb ischemia in 307 (43%). According to the TransAtlantic Inter-Society Consensus II (TASC) classification, the lesions were categorized as type A (104, 15%), type B (171, 24%), type C (170, 24%), and type D (268, 37%). Early (<30 days) endpoints included mortality, thrombosis, and major complications. Late major outcomes were primary and secondary patency and freedom from reintervention as estimated by Kaplan-Meier analysis; estimates are given with the 95% confidence intervals (CIs). Associations between baseline variables and primary patency were sought with multivariate analysis; the results are presented as the hazard ratio (HR) and 95% CI. Results: Technical success was achieved in 708 (99%) lesions; in-hospital mortality was 0.6% (n=4). The median follow-up was 11 months (range 0–42). The estimated primary patency rate was 96% (95% CI 94% to 97%) at 1 year and 94% (95% CI 91% to 96%) at 2 years. The estimated secondary patency was 99% (95% CI 97% to 99%) at 1 year and 98% (95% CI 95% to 99%) at 2 years. The estimated freedom from reintervention was 98% (95% CI 96% to 99%) at 1 year and 97% (95% CI 94% to 98.5%) at 2 years. Cox regression analysis demonstrated that the application of a covered stent was associated with an increased need for reintervention (HR 1.4, 95% CI 1.10 to 1.74, p=0.005). Chronic obstructive pulmonary disease was associated with decreased primary patency (HR 3.7, 95% CI 1.25 to 10.8, p=0.018). Conclusion: Endovascular intervention with primary stent placement for aortoiliac occlusive disease achieved satisfactory 2-year patency regardless of the complexity of the lesion. Almost all TASC lesions should be considered for primary endovascular intervention if suitable.

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