Endovascular management of aorto-iliac occlusive disease (Leriche syndrome)
Huei-Lung Liang1, Ming-Feng Li1, Chia-Chi Hsiao1
1Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung City, Taiwan, ROC.
Insights
Endovascular therapy offers a high success rate for chronic aorto-iliac occlusive disease, providing a viable alternative to surgery for high-risk patients with excellent patency rates.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Chronic aorto-iliac occlusive disease (AIOD), also known as Leriche Syndrome, traditionally treated with bypass grafting.
- Surgical re-intervention for AIOD carries significant mortality risks (up to 25%).
- Limited reports exist for endovascular strategies in Leriche Syndrome, despite a trend towards endovascular approaches for TASC II C and D lesions.
Purpose of the Study:
- To evaluate the efficacy and safety of endovascular therapy for chronic aorto-iliac occlusive disease in high-risk patients.
- To assess technical success, complication rates, and patency outcomes of endovascular treatment for AIOD.
- To determine if endovascular therapy is a suitable alternative to surgical intervention for this patient population.
Main Methods:
- Retrospective review of 15 high-risk patients with chronic AIOD.
- Utilized retrograde approaches (femoral arteries) for shorter occlusions and antegrade approaches (brachial artery) for juxtarenal lesions.
- Employed intraluminal or subintimal angioplasty with stent or stent-graft deployment, including kissing-stent techniques.
Main Results:
- 100% technical success in treating 28 iliac arteries and 14 occluded abdominal aortas.
- Subintimal technique contributed to 25% of successful treatments.
- Two minor complications (vascular rupture, distal emboli) were managed endovascularly; no renal artery emboli occurred.
- Primary patency rates: 92.3% (1 yr), 83.9% (3 yrs), 83.9% (5 yrs). Secondary patency rates: 100% (1, 3, and 5 yrs).
Conclusions:
- Endovascular therapy demonstrates high technical success for chronic AIOD.
- Achieved favorable short- and mid-term primary and secondary patency rates.
- Represents a potentially valid alternative to surgical intervention for high-risk patients with AIOD.
Background:
Bypass grafting is the standard of care for chronic aorto-iliac occlusive disease (AIOD, aka Leriche Syndrome) but is associated with mortality rates of up to 25% if surgical re-intervention is necessary. Despite a recent shift towards an endovascular-first strategy for TransAtlantic InterSociety Consensus II ("TASC II") C and D lesions, reports from Leriche Syndrome are still limited.
Patients And Methods:
15 high-risk patients (11 male, 4 female), mean age of 60.6 years, with chronic aorto-iliac occlusive disease were retrospectively reviewed. Retrograde approaches via the bilateral femoral arteries for aortic occlusion less than 4 cm in length and/or antegrade fashion from the brachial artery for juxtarenal type lesions were made. For the latter, thrombolysis prior to angioplasty was also performed. Intraluminal or if necessary, subintimal angioplasty was performed with deployment of either bare metal stents or stentgrafts in a kissing-stent fashion.
Results:
A total of 28 iliac arteries and 14 occluded abdominal aorta were treated with 100% technical success, of which 25% success were achieved by using subintimal technique. Two minor complications occurred, including vascular rupture and distal emboli in one patient apiece, which were successfully managed via endovascular fashion. There were no complications of renal artery emboli. Primary and secondary patency rates at 1, 3 and 5 years were 92.3% and 100%; 83.9% and 100%; and 83.9% and 100%, respectively.
Conclusion:
Endovascular therapy for chronic aorto-iliac occlusion has a high technical success rate, with good short- and mid-term primary and secondary patency rates and may provide a valid alternative to surgery for high-risk patients.
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