Endovascular treatment of isolated atherosclerotic lesions of the infrarenal aorta is technically feasible with acceptable long-term results

Long-term outcomes of endovascular therapy for aortoiliac bifurcation lesions in the real-AI registry

PURPOSE

To report long-term outcomes of endovascular therapy (EVT) for aortoiliac bifurcation lesions.

METHODS

Patients enrolled in the multicenter REtrospective AnaLysis of Aorto-Iliac stenting (REAL-AI) registry in Japan were pooled. Of 2096 patients who underwent EVT for de novo aortoiliac disease between January 2005 and December 2009, 190 patients (148 men; mean age 70±9 years) had aortoiliac bifurcation lesions that were treated with stents, whose configuration (single, V, or kissing) and type (balloon-expandable or self-expanding) were subjected to regression analysis to determine any impact on primary patency along with other demographic, clinical, and lesion characteristics, including Trans-Atlantic Inter-Society Consensus II C/D classification. The primary endpoints were restenosis and target lesion revascularization (TLR). Secondary endpoints were all-cause death, major cardiovascular events, and major cardiovascular + limb events.

RESULTS

The overall complication rate was 6.3%, and 1- and 5-year primary patency rates were 87% and 73%, respectively. Over a mean follow-up of 31±15 months, there were 36 (19.0%) restenoses, 22 (11.6%) TLRs, and 4 (2.1%) reocclusions; stent fracture (2, 1.1%) and major amputation (2, 1.1%) were rare. Only female gender [adjusted hazard ratio (AHR) 4.26, 95% CI 1.89 to 9.71, p<0.001] and residual diameter stenosis (AHR 1.04, 96% CI 1.01 to 1.06, p=0.01) were independent predictors of primary patency.

CONCLUSION

Stenting for aortoiliac bifurcation lesions was found to be safe and effective. Neither stent configuration nor type appeared to affect vessel patency in true bifurcation lesions.

Percutaneous treatment of severe diffuse stenosis in heavily calcified infrarenal abdominal aorta using iliac extender endoprosthesis: a case series

Severe, concentric calcific stenosis of the infrarenal abdominal aorta (IAA) is an uncommon but technically challenging problem. In diffuse, heavily calcific lesions are generally not treated with balloon expandable or self-expanding stents. There is concern of aortic rupture, incomplete apposition, and underexpansion. Such lesions are mostly treated with aortobifemoral or extra-anatomic bypass surgery. Using three case examples, we describe the feasibility of endovascular treatment for severely calcific IAA with use of iliac extender limbs of commercially available aortic stent grafts and discuss the role of preprocedural CT scan in case planning.

[Focal atherosclerotic abdominal aortic stenosis]

We report a case of a 54-year-old woman presenting a symptomatic focal atherosclerotic abdominal aortic stenosis. Computed tomographic angiography allowed to study the lesion, the abdominal aorta and its main branches. The patient was treated via an endovascular approach using a covered stent. The postoperative course was uneventful and the patient was asymptomatic with a patent reconstruction after 18 months. Improvement in endovascular technology has totally modified the treatment of focal atherosclerotic abdominal aortic stenosis. However, many technical points remain to be determined including the necessity of systematic stenting, the type of stent to use, and the steps of the procedure.

[Eccentric infrarenal aortic stenosis. Surgical and endovascular treatment]

The management of coral reef lesions reported in this case study demonstrates the complementary and non-competing character of the open and endovascular treatment. The minimally invasive procedure of stent-optimized angioplasty seems to be advantageous as the primary therapy in selected cases. In the case of clinical deterioration the endovascular technique allows surgical reconstruction without significantly diminishing the result. Catheter-based techniques therefore remain an additional instrument for treatment in the hands of vascular surgeons which substantially broadens the range of therapy options for this disease entity.