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Endovascular Aortic Repair for Isolated Infrarenal Aortic Stenosis. Ann Vasc Surg 2019; 58:385.e7-385.e9. [PMID: 30763702 DOI: 10.1016/j.avsg.2018.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/16/2018] [Accepted: 11/20/2018] [Indexed: 11/23/2022]
Abstract
An 87-year-old man with severe intermittent claudication and lower limb pain at rest was referred to our hospital for examination. Computed tomography (CT) angiography imaging showed a severe stenosis in the infrarenal abdominal aorta. The ankle brachial indices (ABIs) were 0.62 (right) and 0.60 (left). Endovascular aortic repair was performed with distal protection. The postoperative course was uneventful, and postoperative CT showed no stenosis or distal embolization. The ABI improved to the normal values of 1.02 (right) and 1.13 (left). The patient was followed up as an outpatient without a cane. Long-term follow-up and randomized controlled trials are necessary to clarify the durability and efficacy of the endovascular approach for this aortic pathology.
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Endovascular Aneurysm Sealing for Management of Aortic Occlusive Disease. EJVES Short Rep 2017; 37:14-17. [PMID: 29234734 PMCID: PMC5709297 DOI: 10.1016/j.ejvssr.2017.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 09/05/2017] [Accepted: 10/08/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Endovascular management of aortic occlusive disease is an alternative to open surgery. This case describes the use of a Nellix graft to treat infrarenal aortic stenosis, outwith the graft indication for use. Case report A 71 year old man with multiple comorbidities, presented with bilateral buttock claudication. A computed tomography angiogram (CTA) showed significant infrarenal aortic stenosis. Under local anaesthetic, using a percutaneous approach, Nellix grafts were inserted. The patient was discharged within 24 hours. His claudication improved significantly. A 6 month follow-up CT showed stent patency. Conclusion Although further research is necessary, this case suggests that Nellix is safe and effective for primary stenting of the stenotic infrarenal aorta.
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Affiliation(s)
- Nathan J Aranson
- From Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston
| | - Michael T Watkins
- From Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston.
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Tapping CR, Uberoi R. Iliac arteries: how registries can help improve outcomes. Semin Intervent Radiol 2014; 31:338-44. [PMID: 25435659 DOI: 10.1055/s-0034-1393970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
There are many publications reporting excellent short and long-term results with endovascular techniques. Patients included in trials are often highly selected and may not represent real world practice. Registries are important to interventional radiologists for several reasons; they reflect prevailing practice and can be used to establish real world standards of care and safety profiles. This information allows individuals and centers to evaluate their outcomes compared with national norms. The British Iliac Angioplasty and Stenting (BIAS) registry is an example of a mature registry that has been collecting data since 2000 and has been reporting outcomes since 2001. This article discusses the evidence to support both endovascular and surgical intervention for aortoiliac occlusive disease, the role of registries, and optimal techniques for aortoiliac intervention.
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Affiliation(s)
- Charles Ross Tapping
- Department of Radiology, John Radcliffe Hospital, Oxford, United Kingdom ; Department of Radiology, Churchill Hospital, Oxford, United Kingdom
| | - Raman Uberoi
- Department of Radiology, John Radcliffe Hospital, Oxford, United Kingdom
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5
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Chung TL, Mukherjee D. Successful endovascular management of an aortic rupture following stent placement for severe atherosclerotic stenosis: A case report. Int J Angiol 2012; 16:73-6. [PMID: 22477277 DOI: 10.1055/s-0031-1278253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Aortic rupture during endovascular procedures is a devastating complication that mandates expedient intervention. The present report describes a case in which endovascular treatment was used to successfully manage an aortic rupture following placement of a covered stent graft for severe infrarenal aortic stenosis. Successful management of this case was the result of the procedure being performed in an operating room under appropriate anesthesia and close hemodynamic monitoring. Bilateral common femoral arterial access and use of covered aortic stent grafts also contributed to a favourable outcome.
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Tapping CR, Ahmed M, Scott PM, Lakshminarayan R, Robinson GJ, Ettles DF, Shrivastava V. Primary infrarenal aortic stenting with or without iliac stenting for isolated and aortoiliac stenoses: single-centre experience with long-term follow-up. Cardiovasc Intervent Radiol 2012; 36:62-8. [PMID: 22456847 DOI: 10.1007/s00270-012-0372-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 03/07/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the technical success, complications, long-term clinical outcome, and patency after primary infrarenal aortic stenting for aortic and aortoiliac stenosis. Between January 1999 and January 2006, 22 consecutive patients underwent endovascular treatment because of infrarenal aortic stenosis with and without common iliac stenosis (10 men; mean age 64 ± 14 years). Eleven (11 of 22) patients had an isolated aortic stenosis, whereas 11 of 22 had aortic stenosis that extended into the common iliac arteries (CIAs). Thirteen patients were Rutherford classification type 3, and 9 patients were type 4. Statistical analysis included paired Student t test and Kaplan-Meier life table analysis; p < 0.05 was considered significant. Technical and initial clinical success was achieved in all patients. There were three (14 %) procedure-related complications, which included two access-point pseudoaneurysms and one non-flow-limiting left external iliac dissection. Patients were followed-up for a mean period of 88 months (range 60-132). Mean preprocedure ankle brachial pressure indexes (ABPI) were 0.60 ± -0.15 (right) and 0.61 ± -0.16 (left). After the procedure they were 0.86 ± -0.07 (right) and 0.90 ± -0.09 (left). The increase in ABPI was significant (p < 0.05), and this continued throughout follow-up. Four (18 %) patients had recurrence of symptoms during follow-up. These occurred at 36, 48, 48, and 50 months after the original procedure. All four patients were successfully treated with repeat angioplasty procedures. There was a significant difference in primary patency between isolated aortic stenosis (100 %) and aortoiliac stenosis (60 %) (p = 0.031). Cumulative follow-up was 1920 months yielding a reintervention rate of 0.025/events/year. CONCLUSION Primary stenting of infrarenal stenosis is safe and successful with a low reintervention rate. It should be considered as first-line treatment for patients with infrarenal aortic stenotic disease.
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Affiliation(s)
- C R Tapping
- Department of Radiology, Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, Anlaby Road, Hull, HU3 2JZ, UK
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7
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The Current Management of Aortic, Common Iliac, and External Iliac Artery Disease: Basic Data Underlying Clinical Decision Making. Ann Vasc Surg 2011; 25:990-1003. [DOI: 10.1016/j.avsg.2011.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 04/26/2011] [Accepted: 05/15/2011] [Indexed: 10/17/2022]
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Schwindt AG, Panuccio G, Donas KP, Ferretto L, Austermann M, Torsello G. Endovascular treatment as first line approach for infrarenal aortic occlusive disease. J Vasc Surg 2011; 53:1550-6.e1. [DOI: 10.1016/j.jvs.2011.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 02/08/2011] [Accepted: 02/09/2011] [Indexed: 11/24/2022]
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Schaefer PJ, Mueller-Huelsbeck S, Lukas R, Schaefer FK, Huemme TH, Heller M, Jahnke T. Low-profile primary stent placement for the treatment of focal calcified ulcerated stenosis in the infrarenal aorta. J Vasc Interv Radiol 2008; 19:182-8. [PMID: 18341946 DOI: 10.1016/j.jvir.2007.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Revised: 09/01/2007] [Accepted: 09/09/2007] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To analyze the immediate and midterm success of low-profile stent placement in calcified ulcerated lesions of the infrarenal aorta in patients with arterial occlusive disease. MATERIALS AND METHODS In this prospective case series, 13 symptomatic patients (eight men, five women; mean age, 64.8 years +/- 12.1; age range, 44-84 years) with focal calcified ulcerated stenoses of the infrarenal aorta were treated with stent placement by using a low-profile technique in a radiology intervention center during a 4-year period. Clinical examinations and duplex ultrasonography were used to evaluate the stents? patency and clinical success. Kaplan-Meier graphs were calculated to analyze the freedom-of-symptom rate. RESULTS The initial technical success rate was 92% (12 of 13 patients). Due to extended calcifications, a residual stenosis of 50%-60% remained in one patient. No peri-interventional complications occurred. The mean follow-up was 26 months (range, 5-53 months). During follow-up, one patient had a restenosis after 7 months and presented clinically with Fontaine stage IIb. Two patients had iliac and/or femoral stenoses, and both presented with Fontaine stage IIb. One patient's symptoms originated from the lumbar spine. Primary patency and primary clinical success rates were 85% and 69%, respectively. According to Kaplan-Meier tables, the freedom-from-symptom rates were 92%, 84%, 73%, and 63% at 0, 7, 12, and 21 months, respectively. CONCLUSIONS Low-profile stent placement in calcified, ulcerated lesions of the infrarenal aorta is an effective and safe treatment for symptomatic stenoses in patients with arterial occlusive disease after a mean follow-up of 26 months.
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Affiliation(s)
- Philipp J Schaefer
- Department of Diagnostic Radiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Strasse 9, 24105 Kiel, Germany.
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Primary stenting for aortic lesions: From single stenoses to total aortoiliac occlusions. J Vasc Surg 2008; 47:310-7. [DOI: 10.1016/j.jvs.2007.10.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Revised: 10/09/2007] [Accepted: 10/11/2007] [Indexed: 11/24/2022]
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Primary Self-Expandable Nitinol Stent Placement in Focal Lesions of Infrarenal Abdominal Aorta: Long Term Results. Cardiovasc Intervent Radiol 2007; 31:43-8. [DOI: 10.1007/s00270-007-9222-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 08/20/2007] [Accepted: 09/28/2007] [Indexed: 10/22/2022]
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Uberoi R, Tsetis D. Standards for the Endovascular Management of Aortic Occlusive Disease. Cardiovasc Intervent Radiol 2007; 30:814-9. [PMID: 17659423 DOI: 10.1007/s00270-007-9123-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Accepted: 05/19/2007] [Indexed: 11/29/2022]
Abstract
Occlusive disease of the infrarenal aorta and aorto-iliac arteries can be safely treated by minimally invasive therapy and is now widely available. The aim of this article is to produce standards for the management of these patients using current endovascular techniques.
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Affiliation(s)
- Raman Uberoi
- Department of Radiology, The John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK.
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Poncyljusz W, Falkowski A, Garncarek J, Karasek M, England S, Zawierucha D. Primary stenting in the treatment of focal atherosclerotic abdominal aortic stenoses. Clin Radiol 2006; 61:691-5. [PMID: 16843753 DOI: 10.1016/j.crad.2006.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Revised: 03/20/2006] [Accepted: 04/12/2006] [Indexed: 11/18/2022]
Abstract
AIM To evaluate the results of primary stent placement in focal atherosclerotic aortic stenoses using balloon expandable stents. MATERIALS AND METHODS Twenty-six primary balloon expandable stent placements in the abdominal aorta were performed and reviewed. All the aortic stenoses were atherosclerotic. Patients were followed up by ankle/brachial pressure indices (ABPI) and Doppler ultrasound (US) at 24h after procedure and at 12 and 24 months. Follow-up angiograms were performed at 12 months. RESULTS Twenty-six stents in 26 patients were placed in the infrarenal aorta. All procedures were technically successful and immediate clinical success was obtained. The mean ABPI significantly improved from 0.52+/-0.10 to 0.94+/-0.09 within 24h after procedure, and remained at 0.90+/-0.12 between 12 and 24 months follow-up (mean 18 months). There was full haemodynamic success at hospital discharge and at 12 and 24 months after the procedure. Clinical success at 12 and 24 months (mean 18 months) was defined as an improvement in the Fontaine classification by at least one class compared with the pre-procedure class and was shown to be 100%. CONCLUSION In summary, we report that primary stenting is a safe and effective alternative to surgery in cases of symptomatic stenosis of the infrarenal abdominal aorta. The excellent intermediate term results suggested that we would recommend primary stenting as the treatment of choice for focal atherosclerotic stenoses of the infrarenal aorta in selected patients.
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Affiliation(s)
- W Poncyljusz
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University of Szczecin, SPSK-1, Unii Lubelskiej 1, 71-252, Szczecin, Poland.
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Simons PCG, Nawijn AA, Bruijninckx CMA, Knippenberg B, de Vries EH, van Overhagen H. Long-term results of primary stent placement to treat infrarenal aortic stenosis. Eur J Vasc Endovasc Surg 2006; 32:627-33. [PMID: 16859934 DOI: 10.1016/j.ejvs.2006.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Accepted: 05/11/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the safety and the long-term results of primary stent placement for localized distal aortic occlusive disease. DESIGN Retrospective observational study. PATIENTS AND METHODS From July 1998 to July 2005 17 patients (14 female and 3 men, mean age 57 years (39-80)) were treated for intermittent claudication. Five of these patients underwent additional endovascular treatment of focal iliac lesions. RESULTS Technical success defined as residual stenosis of less than 50% or a trans-stenotic systolic pressure gradient <10% was achieved in 14 of 17 (82%) patients. Major complications included dissection at the puncture site in one patient and thrombosis of additional iliac stents in another patient. Both of these complications were successfully treated. During a mean follow-up of 27 months (range 1-86), four patients had recurrence of symptoms due to in-stent restenoses (n=2), femoral (n=1) or iliac occlusion (n=1), respectively. By Kaplan-Meier analysis, primary aortic hemodynamic patency was 83% at 3 years. Secondary aortic hemodynamic patency was 100%. The primary clinical patency was 68% at 3 years. CONCLUSION Primary stent placement for distal aortic stenoses is an alternative to surgical treatment because of its high patency and relatively low complication rates.
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Affiliation(s)
- P C G Simons
- Department of Radiology, HAGA Hospital, Hague, The Netherlands.
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Stoeckelhuber BM, Stoeckelhuber M, Gellissen J, Kueffer G. Primary Endovascular Stent Placement for Focal Infrarenal Aortic Stenosis: Long-term Results. J Vasc Interv Radiol 2006; 17:1105-9. [PMID: 16868162 DOI: 10.1097/01.rvi.0000228374.85266.64] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The objectives of this retrospective study were to determine the technical success, safety, and long-term results of primary stent implantation in infrarenal aortic stenosis. MATERIALS AND METHODS A total of eight atherosclerotic stenoses and one occlusion of the infrarenal aorta (ie, midaortic syndrome) were treated with endoluminal stent placement after balloon angioplasty. Aortoiliac lesions were excluded. Technical success and patency were assessed. RESULTS Primary technical success in percutaneous transluminal angioplasty and subsequent stent placement was achieved in all patients. No complications occurred, and no morbidity was encountered. Primary clinical patency rates were 100% on all follow-up examinations. Long-term results with a mean follow-up of 110 months (range, 99-117 months) were recorded in seven patients; one patient had died and one was lost to follow-up. CONCLUSIONS In view of the excellent initial results and promising long-term follow-up data in a small series, stent placement after predilation in properly selected patients with isolated infrarenal aortic stenosis appears to be a promising, durable treatment. It should be considered as a primary method of treatment.
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Affiliation(s)
- Beate Maria Stoeckelhuber
- Department of Radiology, Universitätsklinikum des Medizinischen Universität zu Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
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Ruppert V, Wirth S, Rieger J, Kueffer G, Steckmeier B, Stoeckelhuber BM. Long-term Results After Primary Stenting of Distal Aortic Stenosis. J Endovasc Ther 2006; 13:229-36. [PMID: 16643078 DOI: 10.1583/05-1683mr.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To review the long-term results of primary stent placement in the distal aorta above the bifurcation. METHODS Fourteen patients (8 men; mean age 62 years, range 46-82) underwent primary stent implantation performed by an interdisciplinary radiosurgical team. In 10 patients, a long-term follow-up examination consisting of patient history, clinical examination, and duplex sonography was performed. The ankle-brachial index (ABI) for the posterior tibial artery was calculated on the basis of Doppler pressure measurements. RESULTS The clinical success rate at the first follow-up examination (mean 2.9 months, range 2.1-4.4) was 100% (n = 14). The mean baseline ABI of 0.64 +/- 0.12 had risen to 1.02 +/- 0.10 (p < 0.0001). At midterm follow-up (mean 22.8 months, range 14-42) in 12 patients, the ABI was 0.96 +/- 0.12 (p < 0.0001 versus baseline). At a mean 86 months (range 51-119) after stent treatment, the ABI in 10 patients was 0.90 +/- 0.20 (p < 0.0001 versus baseline). Over the long term, the clinical success rate was 70%. Deterioration was due to the progression of atherosclerosis distal to the aorta; duplex sonography showed no aortic restenosis or occlusion. CONCLUSION In view of the excellent long-term results in our small series, primary stent placement in focal abdominal aortic stenosis in properly selected patients is a durable treatment. In addition, the mortality and morbidity risks are markedly reduced compared with open surgery.
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Affiliation(s)
- Volker Ruppert
- Department of Vascular Surgery, Hospital of Ludwig-Maximilian University Munich-Campus Innenstadt, Munich, Germany.
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Schedel H, Wissgott C, Rademaker J, Steinkamp HJ. Primary Stent Placement for Infrarenal Aortic Stenosis: Immediate and Midterm Results. J Vasc Interv Radiol 2004; 15:353-9. [PMID: 15064338 DOI: 10.1097/01.rvi.0000121411.46920.27] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the safety and the long-term clinical and hemodynamic results of primary stent placement of atherosclerotic calcified stenosis of the infrarenal aorta. MATERIAL AND METHODS Between July 1996 and July 1999, 15 patients (nine male, si- female; mean age, 53.9 years) with symptomatic, calcified aortic stenosis were treated with primary stent placement. Patients underwent abdominal aortography and bilateral lower extremity arteriography. Follow-up was performed in all 15 patients. Technical success was defined as residual stenosis of less than 30% or a resting trans-systolic pressure gradient of less than 10 mm Hg after stent placement. Clinical patency was defined as the absence or improvement of symptoms after stent placement. Hemodynamic patency was defined as a normal triphasic Doppler waveform in the common femoral artery, an ankle-brachial index greater than 0.90, or the absence of a thigh-brachial pressure gradient at rest in either limb. RESULTS Technical success was achieved in 13 of 15 patients. The two patients considered to be technical failures had resting trans-systolic pressure gradients of 12 and 13 mm Hg, respectively, after stent placement. After the mean follow-up of 36 months, primary clinical and hemodynamic patency rates were 85% and the secondary hemodynamic patency rate was 100%. Two of five symptomatic recurrences during the 36-month follow-up period (range, 12-46 months) were a result of aortic restenosis and were treated with repeated percutaneous transluminal angioplasty. None of the patients required aortic surgery. Complications of the primary procedure included one puncture site infection, one pseudoaneurysm, and one distal embolization, which delayed discharge of three patients. There was no morbidity during the secondary interventions. CONCLUSION Primary stent placement as treatment of calcified infrarenal aortic stenosis proved to be safe and also provided durable long-term clinical improvement.
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Affiliation(s)
- Hannes Schedel
- Reha-Klinik, Kellberg bei Passau, Department of Radiology, Berlin, Germany
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Yilmaz S, Sindel T, Yeğin A, Erdoğan A, Lüleci E. Primary Stenting of Focal Atherosclerotic Infrarenal Aortic Stenoses: Long-Term Results in 13 Patients and a Literature Review. Cardiovasc Intervent Radiol 2004; 27:121-8. [PMID: 15259805 DOI: 10.1007/s00270-003-2724-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We conducted this study to investigate the value of primary stent implantation for the endovascular treatment of focal atherosclerotic stenoses of the infrarenal abdominal aorta. The data of 13 patients with a localized complex infrarenal aortic stenosis who underwent primary stenting was retrospectively evaluated. The patients (6 females, 7 males) had a mean age of 57.3 +/- 9.1 years (mean +/- SD). In all patients, the aortic diameter was measured on CT sections, and a self-expanding endoprosthesis was primarily implanted followed by dilatation with single or double balloons. In 3 patients, additional distal stenoses were also endovascularly treated. The procedure was technically successful in all patients. No complications occurred except for 2 minor groin hematomas. During the 43 +/- 23 months (mean +/- SD) follow-up (range: 12-96 months), all stented aortic segments remained patent. Clinical patency was lost in 4 patients, which was due to atherosclerosis or restenosis distal to the aorta. In view of the excellent early and long-term results, we believe that primary stenting should be considered the first line treatment in properly selected patients with focal atherosclerotic infrarenal stenoses of the abdominal aorta.
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Affiliation(s)
- Saim Yilmaz
- Department of Radiology, Akdeniz University School of Medicine, Arapsuyu, Antalya, Turkey.
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Stoeckelhuber BM, Meissner O, Stoeckelhuber M, Wiesmann M, Kueffer G. Primary Endovascular Stent Placement for Focal Infrarenal Aortic Stenosis: Initial and Midterm Results. J Vasc Interv Radiol 2003; 14:1443-7. [PMID: 14605111 DOI: 10.1097/01.rvi.0000096768.74047.1e] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The objectives of this retrospective study were to determine the technical success, safety, and midterm results of primary stent placement of infrarenal aortic stenosis. Eight stenoses and one occlusion were treated with stent placement after balloon pre-dilation. Primary technical success was achieved in all patients. Five patients showed reperfusion or restored normal direction of flow of the inferior mesenteric artery. No complications occurred. There was a mean follow-up of 12 months (range, 3-20 months). Primary clinical and hemodynamic patency rates were 100% on follow-up examinations. Stent placement after balloon pre-dilation in properly selected patients with isolated infrarenal aortic stenosis is a promising durable treatment.
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Affiliation(s)
- Beate Maria Stoeckelhuber
- Department of Radiology, Universitätsklinikum der Medizinischen Universität zu Lübeck, Lübeck, Germany.
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d'Othée BJ, Haulon S, Mounier-Vehier C, Beregi JP, Jabourek O, Willoteaux S. Percutaneous endovascular treatment for stenoses and occlusions of infrarenal aorta and aortoiliac bifurcation: midterm results. Eur J Vasc Endovasc Surg 2002; 24:516-23. [PMID: 12443747 DOI: 10.1053/ejvs.2002.1751] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE evaluation and comparison of the endovascular treatment of isolated aortic and aortoiliac atherosclerotic lesions (stenoses and occlusions). METHODS a percutaneous endovascular procedure was performed in 52 patients (38 men and 14 women) with a mean age of 52 years (range, 25-85 years). The baseline angiogram showed 35 aortic lesions (31 stenoses, 4 occlusions) and 17 aortoiliac lesions (14 stenoses, 3 occlusions). Percutaneous techniques used in this series included variable combinations of transluminal angioplasty and stenting. All stents placements were performed over-the-wire using the transfemoral route (most often bilateral approach). Clinical examination and Duplex-scan were performed at discharge, 1 month, 6 months, 12 months, and then yearly. RESULTS technical success was 100% for aortic and aortoiliac lesions. Angiographic success rates were comparable for aortic (91%) and aortoiliac (94%) lesions. No death occurred during or early after the endovascular intervention. Duplex-scan confirmed 100% patency rate at discharge. There was no significant difference between the aortic (94%) and aortoiliac (96%) groups regarding immediate clinical improvement. Mean follow-up was 34+/-31 months (range, 0-130 months). The cumulative primary patency rate at 36 months was 85% in the aortic group and 86% in the aortoiliac group. Clinical success, defined as a symptom-free status at the end of follow-up, was also similar in both groups. CONCLUSION endovascular treatment of isolated aortic lesions of the infra-renal aorta has favorable outcomes comparable to those of aortoiliac lesions.
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Affiliation(s)
- B J d'Othée
- Department of Vascular Radiology, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France
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Derom A, Vermassen F, Ongena K. PTA and stenting after previous aortoiliac endarterectomy. Eur J Vasc Endovasc Surg 2001; 22:130-3. [PMID: 11472045 DOI: 10.1053/ejvs.2001.1441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES to evaluate the feasibility and long-term results of angioplasty and stenting in the treatment of restenosis following aortoiliac endarterectomy. MATERIALS AND METHODS between 1991 and 1999 19 patients underwent angioplasty with selective stenting for recurrent stenosis after previous aortoiliac endarterectomy. Aortic lesions were treated five times in four patients. At the iliac level 28 lesions (25 stenosis and three occlusions) were treated in 16 patients (one patient had a stenosis at the aortic as well as iliac level). All patients were followed clinically and by ultrasound. In the second half of 1999, an angiogram or spiral CT-angiography was performed in all patients to determine long-term outcome. RESULTS technical success was obtained in all patients and clinical success was achieved in 18 of the 19 patients. Angiographic cumulative primary patency for aortoiliac lesions was 96% at 1 year and 76% at 3 years. CONCLUSIONS angioplasty with selective stenting of recurrent aortoiliac disease after previous aortoiliac endarterectomy is feasible and safe. Long-term clinical and angiographic patency rates are in accordance with results of aortoiliac angioplasty in general.
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Affiliation(s)
- A Derom
- Department of Surgery, Hospital De Honte, Terneuzen, The Netherlands
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22
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Saha S, Gibson M, Torrie EP, Magee TR, Galland RB. Stenting for localised arterial stenoses in the aorto-iliac segment. Eur J Vasc Endovasc Surg 2001; 22:37-40. [PMID: 11461100 DOI: 10.1053/ejvs.2001.1409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE to determine complications and patency following angioplasty (PTA) and stenting of aorto-iliac stenoses. SETTING District General Hospital in U.K. DESIGN prospective observational study. PATIENTS AND METHODS between December 1994 and June 2000, 50 patients (38 men), median age 64 (41-89) years underwent aorto-iliac stenting. A total of 61 stents were placed. Indications were intermittent claudication in 38 and rest pain, ulceration or gangrene in 12. Sites stented were aorta 11, common iliac artery 32, external iliac artery 14, common and external iliac arteries two. Bilateral iliac procedures were carried out in nine. Two stents were used to correct residual stenoses after aortic stenting. Some 11 recurrent stenoses were treated. The other reasons for stenting were residual stenoses greater than 30% after PTA, tight calcified stenoses or when a stenosed iliac artery was being used as a donor prior to crossover or femoropopliteal bypass. RESULTS two immediate technical failures occurred due to malposition. Residual stenoses were corrected by PTA. Two further patients sustained minor complications. None of the aortic stents occluded through two required secondary procedures. Primary-assisted patency was thus 100% at three years. Primary patency following iliac stenting for claudication and critical ischaemia were 97% and 86% at three years respectively. CONCLUSION PTA and stenting of aorto-iliac stenoses can be safely achieved with durable results.
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Affiliation(s)
- S Saha
- Department of Surgery, Royal Berkshire Hospital, London Road, Reading, RG1 5AN, UK
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23
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Therasse E, Côté G, Oliva VL, Cusson JR, Wistaff R, Nguyen PV, Bui BT, Perreault P, Lamarre L, Soulez G. Infrarenal Aortic Stenosis: Value of Stent Placement after Percutaneous Transluminal Angioplasty Failure. Radiology 2001; 219:655-62. [PMID: 11376250 DOI: 10.1148/radiology.219.3.r01jn19655] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the long-term clinical and hemodynamic effectiveness of aortic stent placement in cases of failure of intended infrarenal percutaneous transluminal aortic angioplasty (PTAA). MATERIALS AND METHODS Fifty-three patients who underwent technically successful PTAA were compared with 24 patients who underwent aortic stent placement because of PTAA failure (19 patients) or ulcerated lesions (five patients) that otherwise would have been treated surgically because of the embolization hazard associated with PTAA alone. Clinical patency was defined as the absence or improvement of symptoms after the intervention. Hemodynamic patency was defined as a normal Doppler waveform in the common femoral arteries, an ankle-brachial index greater than 0.95, or the absence of a thigh-brachial pressure gradient. RESULTS Three-year clinical and hemodynamic patency rates, respectively, were 85% and 79% for PTAA and 69% and 43% for aortic stent placement. No morbidity was encountered. With use of the Cox proportional hazards model, two significant risk factors were retained for restenosis: unchanged smoking habit (P =.04) and small dilatation diameter (P =.001). Aortic stent placement, performed in patients with a smaller aortic diameter (10.3 vs. 12.7 mm for PTAA), appeared to be a predictive factor for restenosis by using univariate analysis. By using the Cox proportional hazards model, however, the restenosis rates after PTAA and aortic stent placement were not significantly different. CONCLUSION When aortic diameter is taken into consideration, there is no evidence that clinical outcome after secondary aortic stent placement would be poorer than technically successful PTAA.
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Affiliation(s)
- E Therasse
- Depts of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 3840 St Urbain St, Montreal, Quebec, Canada.
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24
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Karkos CD, D'Souza SP, Hughes R. Primary stenting for chronic total occlusion of the infrarenal aorta. J Endovasc Ther 2000; 7:340-4. [PMID: 10958302 DOI: 10.1177/152660280000700415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To present a rare case of chronic total occlusion of the infrarenal aorta treated with a self-expanding endoluminal stent implanted without preliminary dilation. METHODS AND RESULTS A 68-year-old woman presented with severe bilateral buttock and thigh claudication. Angiography revealed total occlusion of the infrarenal abdominal aorta and relatively normal iliac vessels. Via a right groin puncture and a 9-F sheath, a 14-mm x 5-cm self-expanding Wallstent was deployed in the abdominal aorta and expanded with an angioplasty balloon. Completion angiography showed successful recanalization of the aorta with satisfactory distal flow. Palpable distal pulses were restored, and the patient's symptoms were alleviated. She remained asymptomatic until her death from a major stroke 11 months after aortic stent implantation. CONCLUSIONS Primary stenting may be considered a viable alternative to conventional surgery in selected patients with total infrarenal aortic occlusion.
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Affiliation(s)
- C D Karkos
- Department of Vascular Surgery, Royal Preston Hospital, England, UK.
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25
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26
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AL-MUBARAK NADIM, LIU MINGW, DEAN LARRYS, AL-SAIF SHUKRIM, AL-SHAIBI KHALIDF, TYER SIRAMS, ROUBIN GARYS. Primary Stenting of Infrarenal Abdominal Aortic Stenoses: A Report of Seven Cases and Review of the Literature. J Interv Cardiol 2000. [DOI: 10.1111/j.1540-8183.2000.tb00273.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Nyman U, Uher P, Lindh M, Lindblad B, Ivancev K. Primary stenting in infrarenal aortic occlusive disease. Cardiovasc Intervent Radiol 2000; 23:97-108. [PMID: 10795833 DOI: 10.1007/s002709910021] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the results of primary stenting in aortic occlusive disease. METHODS Thirty patients underwent primary stenting of focal concentric (n = 2) and complex aortic stenoses (n = 19), and aortic or aorto-iliac occlusions (n = 9). Sixteen patients underwent endovascular outflow procedures, three of whom also had distal open surgical reconstructions. Median follow-up was 16 months (range 1-60 months). RESULTS Guidewire crossing of two aorto-biiliac occlusions failed, resulting in a 93% (28/30) technical success. Major complications included one access hematoma, one myocardial infarction, one death (recurrent thromboembolism) in a patient with widespread malignancy, and one fatal hemorrhage during thrombolysis of distal emboli from a recanalized occluded iliac artery. One patient did not improve his symptoms, resulting in a 1-month clinical success of 83% (25/30). Following restenting the 26 stented survivors changed their clinical limb status to +3 (n = 17) and +2 (n = 9). During follow-up one symptomatic aortic restenosis occurred and was successfully restented. CONCLUSIONS Primary stenting of complex aortic stenoses and short occlusions is an attractive alternative to conventional surgery. Larger studies with longer follow-up and stratification of lesion morphology are warranted to define its role relative to balloon angioplasty. Stenting of aorto-biiliac occlusions is feasible but its role relative to bypass grafting remains to be defined.
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Affiliation(s)
- U Nyman
- Department of Radiology, Malmö University Hospital, University of Lund, Sweden
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28
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Elkouri S, Hudon G, Demers P, Lemarbre L, Cartier R. Early and long-term results of percutaneous transluminal angioplasty of the lower abdominal aorta. J Vasc Surg 1999; 30:679-92. [PMID: 10514207 DOI: 10.1016/s0741-5214(99)70107-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to determine the early and long-term results of percutaneous transluminal angioplasty (PTA) of atherosclerotic lower abdominal aorta stenosis. METHODS This study was performed as a retrospective study. From 1980 to 1997, 46 patients with chronic lower limb ischemia with moderate to severe claudication as the result of isolated infrarenal disease or aortoiliac disease underwent PTA. All patients underwent angiography before and after angioplasty and Doppler ultrasound scan examination with ankle-brachial index determination. No stents were used. RESULTS The technical success rate was 96% (44 of 46 cases). Thirty-eight patients (83%) immediately showed clinical, hemodynamic, and angiographic improvement. The initial success rate for patients with isolated infrarenal or bifurcation disease was 92%, whereas it was 71% for aortoiliac disease. Among the eight patients with no initial improvement, four had clinical deterioration and two required emergency surgical revascularization. There were no other complications. Fifty-six percent of the patient conditions (95% confidence interval [CI], 38% to 74%) remained clinically improved at the 5-year follow-up examination. Recurrence of symptoms was caused by femoropopliteal disease in most patients. The primary patency rate assumed with maintenance of hemodynamic improvements was 70% (95% CI, 52% to 88%) and 64% (95% CI, 44% to 84%) at 4 and 5 years of follow-up, respectively. The primary patency rate at 4 years for patients with isolated infrarenal or bifurcation disease was 83% (95% CI, 64% to 100%), whereas it was 55% for aortoiliac disease (95% CI, 30% to 80%; P =.06) The variables that were statistically predictive of patency failure were poor runoff (P =. 01) and presence of aortoiliac atherosclerotic disease (P =.04). CONCLUSION Our results suggest that PTA is an excellent treatment for chronic arterial insufficiency of the lower extremities as the result of isolated atherosclerotic lower abdominal aortic occlusive lesions because of good long-term patency. Aortic PTA for those patients with iliac involvement or with poor runoff gives acceptable results but carries lower patency and clinical success rates.
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Affiliation(s)
- S Elkouri
- Department of Cardiovascular Surgery, Montreal Heart Institute, Québec, Canada
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30
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Abstract
The most common cause of morbidity and mortality in the United States is vascular disease, which afflicts a wide spectrum of organs such as the heart (cardiovascular system), brain (cerebrovascular system), kidney (renal system), liver (hepatic system), and extremities (peripheral vascular system). The most common pathology of vascular diseases is occlusion. Percutaneous Transluminal Angioplasty (PTA) is currently the most common nonsurgical treatment for obstructive arteries. Unfortunately, the long-term effectiveness of PTA is limited by a high restenosis rate. Efforts to reduce post-PTA restenosis, including laser, mechanical atherectomy, intravascular stenting, and pharmacologic agents, have not been successful. With recent advances in the pathogenesis of restenosis, we have learned that the major problem is the intimal hyperplastic reaction in response to vessel injury. Encouraging animal data in the use of various radiotherapeutic approaches to prevent restenosis has led to a large number of multi-national, multicenter, randomized trials on coronary vascular systems. Because early results have been in favor of radiation therapy, and because the basic process of restenosis is similar for coronary and noncoronary vascular systems, many investigators extend the application of radiotherapy to the prevention of restenosis in peripheral vascular systems. However, the clinical scenarios are much different for peripheral vascular systems than for the coronary vascular system. This article discusses the current views of the pathophysiology of restenosis, major clinical trials, and perspectives on future studies. Experimental studies on animal models have documented the profound effects of endovascular brachytherapy in reducing restenosis caused by angioplasty and stenting. Early results of clinical trials are encouraging and confirm these positive results. Long-term follow-up data are needed to show that radiation does prevent, not merely delay, restenosis; Several areas of opportunity exist for both basic science research and clinical studies to enhance our knowledge of the pathophysiology. This would optimize the treatment strategy, maximizing the benefits and minimizing late complications.
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Affiliation(s)
- P Tripuraneni
- Division of Radiation Oncology, Scripps Clinic, La Jolla, CA 92037, USA
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Westcott MA, Bonn J. Comparison of conventional angioplasty with the Palmaz stent in the treatment of abdominal aortic stenoses from the STAR registry. SCVIR Transluminal Angioplasty and Revascularization. J Vasc Interv Radiol 1998; 9:225-31. [PMID: 9540904 DOI: 10.1016/s1051-0443(98)70261-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To retrospectively compare the safety and short-term efficacy of conventional percutaneous transluminal angioplasty (PTA) and PTA with the Palmaz balloon-expandable intravascular stent for the treatment of infrarenal abdominal aortic atherosclerotic stenoses. PATIENTS AND METHODS The records of 25 patients with infrarenal aortic stenoses treated by means of percutaneous techniques were retrieved from the SCVIR Transluminal Angioplasty and Revascularization (STAR) Registry and analyzed. Thirteen patients were treated with PTA alone and 12 were treated with the Palmaz intravascular stent. RESULTS Technical success was achieved in 92% of patients treated with PTA alone and in 100% of those treated with the Palmaz stent. Significant improvements in lesion morphology, hemodynamics, clinical status, and ankle arm indexes were shown in both groups. There was no statistically significant difference in percent stenosis reduction, decrease in trans-stenotic gradient, or initial clinical outcome between the group treated by means of PTA and the group treated by means of PTA with the Palmaz stent. CONCLUSIONS PTA and intravascular stent placement of atherosclerotic stenoses involving the infrarenal aorta are both safe and efficacious therapeutic modalities. At present, it does not appear that primary stent placement confers any short-term benefits over technically successful PTA in aortic stenoses.
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Affiliation(s)
- M A Westcott
- Thomas Jefferson University Hospital, Division of Cardiovascular and Interventional Radiology, Philadelphia, Pennsylvania, USA
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