Emerging role of endovascular grafts in complex aortoiliac occlusive disease
Ahsan T Ali1, J Gregory Modrall, Jorge Lopez
1Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Insights
Endovascular grafts offer a viable alternative to aortobifemoral bypass for high-risk patients with advanced aortoiliac occlusive disease, demonstrating good clinical outcomes and acceptable patency rates.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aortoiliac Disease Management
Background:
- Aortobifemoral bypass is the standard treatment for complex aortoiliac occlusive disease.
- High-risk patients often present challenges for conventional surgical approaches.
Purpose of the Study:
- To evaluate endovascular grafts as an alternative to aortobifemoral bypass.
- To assess outcomes in high-risk patients with advanced aortoiliac occlusive disease.
Main Methods:
- Endovascular grafts were placed in 23 limbs across 22 patients with TASC C/D lesions.
- Procedures were performed in the operating room with digital fluoroscopy and surgical exposure for closure.
- Concomitant infrainguinal procedures were performed in 6 patients.
Main Results:
- Initial technical success was 95.2% with no 30-day mortality.
- Primary patency at 24 months was 84.2%, with a limb salvage rate of 95.3%.
- Ankle-brachial index significantly improved from 0.49 to 0.87 (P <.001).
Conclusions:
- Endovascular grafting is a viable option for advanced aortoiliac occlusive disease in high-risk patients.
- The technique yields good clinical outcomes and acceptable short-term patency.
- It presents a promising alternative to conventional surgical revascularization.
Background:
Aortobifemoral bypass is the standard therapy for complex aortoiliac occlusive disease. The purpose of this study was to examine the use of endovascular grafts as an alternative to aortobifemoral bypass in patients with advanced aortoiliac occlusive disease at high risk.
Methods:
Endovascular grafts were placed in 23 limbs in 22 patients with TransAtlantic Inter-Society Consensus document (TASC) type C and D lesions. All procedures were performed in the operating room, and images were obtained with portable digital fluoroscopy. Surgical exposure of the ipsilateral common femoral artery was performed to enable safe closure of 9F to 12F sheath sites and to facilitate ipsilateral interventions in the distal external iliac artery. Concomitant infrainguinal outflow procedures were performed in 6 patients.
Results:
Twenty of 22 patients were men; mean patient age was 63.2 +/- 3.2 years. Indications for intervention were rest pain in 12 of 23 limbs and tissue loss in 9 of 22 limbs. Risk factors included hostile abdomen or pelvis in 8 patients, coronary artery disease in 11 patients, end-stage renal disease in 3 patients, and severe chronic obstructive pulmonary disease in 3 patients. Each patient received a mean of 1.6 grafts. Initial technical success was 95.2%, with one technical failure. There was no 30-day mortality. All patients experienced at least one grade improvement per Society for Vascular Surgery reporting standards. Primary patency at 24 months was 84.2% +/- 8.0%, with a limb salvage rate of 95.3% +/- 5.0%. Mean (+/- SD) ankle brachial index improved from 0.49 +/- 0.22 to 0.87 +/- 0.26 (P <.001).
Conclusion:
Endovascular grafting to treat advanced aortoiliac occlusive disease can be accomplished with good clinical outcome and acceptable short-term patency. This endovascular technique can be a viable alternative to conventional surgical revascularization in patients with advanced aortoiliac occlusive disease at high risk.
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