Mid-term results of endovascular reconstruction for aorto-iliac obstructive disease
G Piffaretti1, M Tozzi, C Lomazzi
1Division of Vascular Surgery, Department of Surgery, University of Insubria-Varese, Varese, Italy. gabriele.piffaretti@tiscali.it
Insights
Endovascular repair using the kissing-stents technique offers a viable option for complex aorto-iliac obstructive disease, demonstrating high patency rates and low complication rates in high-risk patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Techniques
Background:
- Aorto-iliac obstructive disease traditionally requires open surgical repair like endarterectomy or bypass grafting.
- Complex lesions at the aorto-iliac bifurcation present significant reconstructive challenges.
- The kissing-stents technique has emerged as a potential endovascular solution.
Purpose of the Study:
- To evaluate the efficacy and safety of endovascular repair for complex aorto-iliac obstructive disease.
- To assess the outcomes of the kissing-stents technique in managing aorto-iliac bifurcation lesions.
- To determine patency rates and complication incidence in patients treated with this endovascular approach.
Main Methods:
- A retrospective analysis of 43 patients with complex aorto-iliac occlusions (TASC C/D) treated between 1999 and 2005.
- Endovascular repair utilizing the kissing-stents technique, often preceded by kissing-balloons angioplasty.
- Follow-up included clinical examination and imaging (duplex ultrasound or CT-angiography) up to 60 months.
Main Results:
- The kissing-stents technique was employed in 69.7% of cases, with kissing-balloons used in the remainder.
- Major complications occurred in 4.6% of patients, with a mean hospitalization of 4.1 days.
- Primary patency rates at 12, 24, and 60 months were 92%, 85.7%, and 80.7%, respectively; overall secondary patency was 93%.
- Four re-occlusions were detected during a mean follow-up of 32.4 months.
Conclusions:
- Endovascular repair with the kissing-stents technique is a safe and effective treatment for complex aorto-iliac obstructive disease.
- This approach is particularly suitable for patients with high operative risk or those who decline conventional surgery.
- The technique provides durable patency and acceptable complication rates for challenging bifurcation lesions.
Aim:
Aorto-iliac obstructive disease has been traditionally treated with endarterectomy and/or a surgical bypass graft. Kissing-stents technique has been proposed to reconstruct the aorto-iliac bifurcation for complex aorto-iliac lesions.
Methods:
We report 43 patients with complex aorto-iliac occlusions managed with endovascular repair. Between March 1999 and October 2005, a total of 43 patients with a mean age of 66+/-10 years underwent endovascular treatment for aorto-iliac obstructive disease. Lesions were classified C (n=34) and D (n=9), accordingly to the Trans-Atlantic Inter-Society Consensus (TASC) classification. All endovascular interventions were performed in the theatre under regional anesthesia. Predilation with kissing-balloons angioplasty was usually performed; the bifurcation was then eventually reconstructed using bilateral stents placed with the kissing technique. Clinical examination and duplex scans or computed tomography-angiography (CT-A) were performed at discharge and 1, 6, and 12 months after the procedure, with yearly studies thereafter.
Results:
Kissing-stents technique was selectively used in 30 cases (69.7%); the remainder cases were treated with kissing-balloons. Major complications occurred in 2 patients (4.6%). Overall, mean hospitalization was 4.1+/-2.8 days (median 3 days). Mean follow-up was 32.4 months (range 1-84 months; median 36 months). During the follow-up, 2 patients (4.6%) died. Duplex and/or CT-A examination detected 4 re-occlusions. Primary patency rates at 12, 24, and 60 months were 92%, 85.7%, and 80.7%, respectively; overall secondary patency rate was 40/43 patients.
Conclusions:
We consider this approach most appropriate for patients deemed at high operative risk for conventional repair or for those who refuse surgery.
