Surgical revascularization of unilateral aortoiliac occlusive disease via retroperitoneal approach with paramedian incision

The question remains as to whether patients presenting with aortoiliac occlusive disease (AIOD) or abdominal aortic aneurysms (AAAs) have similar outcomes when concomitant renal artery reconstructions are performed. In this study, we analyzed our experience with simultaneous aortic and renal reconstructions using a retroperitoneal approach. Over a 5-year period, all patients with either AAAs > 5 cm or symptomatic AIOD who were found to have high-grade renal artery stenosis and who underwent aortic reconstructions with concomitant renal revascularization were analyzed through our vascular surgery registry. Morbidity and mortality were quantitatively evaluated. Data were analyzed using the chi-square test. A total of 1,133 patients with AAA ( n = 832) and AIOD ( n = 301) underwent aortic reconstructions. Two hundred thirty-one patients had 283 concomitant renal revascularizations, including bypass, reimplantation, and endarterectomy, for high-grade (> 70%) renal artery stenosis via a left retroperitoneal approach. The mortality rate of AAA repair with and without renal revascularization was 2.3% (4/178) and 1.5% (10/654), respectively, and that of aortobifemoral bypass for AIOD with and without renal revascularization was 5.7% (3/53) and 2.8% (7/248), respectively. Of the 7 deaths in patients requiring aortic and renal reconstructions, 4 occurred in patients with bilateral renal revascularization. Transient renal insufficiency, ischemic colitis, and cardiopulmonary failure occurred in 5.6%, 2.2%, and 9.6% of patients with AAA repair and in 5.7%, 0%, and 9.4% of patients with AIOD. Two patients developed acute occlusion of their renal bypasses; one was successfully revised, whereas the other led to a nephrectomy. In patients with AAAs, AIOD, and high-grade renal artery stenosis, simultaneous aortic and renal reconstructions can be performed through a retroperitoneal approach with a limited and acceptable mortality. With concomitant renal and aortic procedures, patients with AIOD have a higher mortality when compared with those with AAAs, although this difference is not statistically significant.

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Comparison between the transabdominal and retroperitoneal approach and non-anatomical approach for reconstructive surgery of the aortoiliac occlusive disease.

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.18.406 ◽

1988 ◽

Vol 18 (3) ◽

pp. 406-408

Author(s):

M. Ohhira

Keyword(s):

Reconstructive Surgery ◽

Occlusive Disease ◽

Retroperitoneal Approach ◽

Aortoiliac Occlusive Disease

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Paramedian retroperitoneal approach for revascularization of aortoiliac occlusive disease

Turkish Journal of Thoracic and Cardiovascular Surgery ◽

10.5606/tgkdc.dergisi.2015.11177 ◽

2015 ◽

Vol 23 (4) ◽

pp. 672-677

Author(s):

Bilgin Emrecan

Keyword(s):

Occlusive Disease ◽

Retroperitoneal Approach ◽

Aortoiliac Occlusive Disease

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Faculty Opinions recommendation of A comparison of covered vs bare expandable stents for the treatment of aortoiliac occlusive disease.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13398973.14768082 ◽

2011 ◽

Author(s):

Norman Hertzer

Keyword(s):

Occlusive Disease ◽

Aortoiliac Occlusive Disease

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Transbrachial and transfemoral approaches combined with visceral protection for the treatment of juxtarenal aortoiliac occlusive disease: Technical issues and clinical outcomes

Vascular ◽

10.1177/17085381211023229 ◽

2021 ◽

pp. 170853812110232

Author(s):

Peixian Gao ◽

Changliang Li ◽

Xuejun Wu ◽

Gang Li ◽

Dianning Dong ◽

...

Keyword(s):

Endovascular Treatment ◽

Bare Metal Stents ◽

Covered Stent ◽

Occlusive Disease ◽

Metal Stents ◽

Infrarenal Aorta ◽

Bare Metal ◽

Stent Grafts ◽

Aortoiliac Occlusive Disease

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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