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Primary stenting for aortic lesions: from single stenoses to total aortoiliac occlusions
Chris Klonaris1, Athanasios Katsargyris, Nikolaos Tsekouras
1First Department of Surgery, Vascular Division, LAIKON Hospital, Athens University Medical School, Athens, Greece. chris_klonaris@yahoo.com <chris_klonaris@yahoo.com>
Insights
Primary stenting is a safe and effective treatment for infrarenal aortic occlusive disease, including stenoses and occlusions. This minimally invasive procedure significantly improves blood flow and clinical outcomes for patients with severe symptoms.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Therapy
Background:
- Infrarenal aortic occlusive disease presents a spectrum of challenges, including stenosis and chronic total occlusions.
- Patients often experience severe claudication, ischemic rest pain, or tissue loss, impacting quality of life.
- Some patients with aortic occlusive disease also have comorbidities such as chronic renal failure.
Purpose of the Study:
- To assess the feasibility, safety, and efficacy of primary stenting for infrarenal aortic atherosclerotic stenoses and occlusions.
- To evaluate the clinical and hemodynamic outcomes of endovascular treatment in this patient cohort.
Main Methods:
- A prospective study involving 12 patients with infrarenal aortic occlusive disease between 2003 and 2006.
- Patients underwent primary stenting for aortic stenosis (n=8) or chronic total aortobiiliac occlusion (n=4).
- Clinical assessment included ankle-brachial index (ABI) measurements pre- and post-procedure, with a mean follow-up of 18.3 months.
Main Results:
- Technical success rate was 91.7%, with 100% clinical and immediate hemodynamic success.
- Mean resting ABI significantly improved post-stenting (0.56 to 0.97 right; 0.59 to 0.95 left, P < .01).
- Primary clinical and hemodynamic patency was 91.7% at follow-up, with no reinterventions required; one access-related hematoma occurred.
Conclusions:
- Primary stenting is a feasible, safe, and effective approach for the full range of infrarenal aortic occlusive disease.
- It is recommended as a first-line treatment for infrarenal aortic stenoses.
- Primary stenting offers a viable alternative to surgical intervention for chronic total aortoiliac occlusions.
Purpose:
This study evaluated the feasibility, safety, and efficacy of primary stenting in atherosclerotic stenoses and occlusions of the infrarenal aorta.
Methods:
Between January 2003 and December 2006, 12 patients (6 men) with a mean age of 66.3 +/- 4.1 years who had infrarenal aortic occlusive disease were treated with primary stenting (aortic stenosis, 8; chronic total aortobiiliac occlusion, 4). Reasons for referral were severe claudication in six patients (50%), ischemic rest pain in four (33.3%), and minor tissue loss in two (16.7%). Three patients (25%) had chronic renal failure and were on dialysis. Follow-up was performed in all 12 patients.
Results:
Technical success was 91.7% because one patient had a residual stenosis >30% after stent placement and balloon postdilation owing to severe calcification of the aorta. However, clinical and immediate hemodynamic success was achieved in all 12 patients (100%). The preprocedural mean resting ankle-brachial index (ABI) values of 0.56 +/- 0.13 at the right side and 0.59 +/- 0.15 at the left were increased to 0.97 +/- 0.04 and 0.95 +/- 0.06, respectively, after treatment (P < .01). At the end of the mean follow-up of 18.3 months (range, 6-37 months), the primary clinical and hemodynamic patency was 91.7% +/- 7.98%, and the mean resting ABI values were 0.96 +/- 0.04 for the right and 0.92 +/- 0.1 for the left side (P < .01 compared with preinterventional values). None of the patients in the study underwent reintervention. An access-related groin hematoma developed in one patient, but no other major or minor complications occurred. One patient died 8 months after the procedure of chronic renal failure complications.
Conclusion:
Primary stenting is feasible, safe, and effective for the whole spectrum of aortic occlusive disease. Especially for patients with infrarenal aortic stenoses, it is recommended as the first-line treatment and should be considered as a viable alternative to surgery for total aortoiliac occlusions.
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