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Endovascular Reconstruction for Total Aorto-Iliac Occlusion
Gabriele Piffaretti1, Aaron Thomas Fargion2, Walter Dorigo2
1Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, ASST Settelaghi Universitary Teaching Hospital, Varese, Italy.
Insights
Endovascular treatment for total aortic occlusion showed high technical success and promising 3-year patency rates. These outcomes were achieved using percutaneous and hybrid techniques, unaffected by occlusion extent or method.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aorto-Iliac Disease
Background:
- Aorto-iliac occlusive disease, particularly total occlusion, presents complex challenges for treatment.
- Endovascular techniques offer a less invasive approach compared to open surgery.
Purpose of the Study:
- To analyze the outcomes of endovascular treatment for total occlusion of the infrarenal aorta and aorto-iliac bifurcation.
- To assess technical success, mortality, patency rates, and need for conversion to open surgery.
Main Methods:
- A multicenter, retrospective, observational cohort study included 54 patients with total infrarenal aorta and aorto-iliac bifurcation occlusion.
- Patients underwent percutaneous or hybrid endovascular revascularization, with techniques like kissing-stent-graft, CERAB, or unibody endograft.
- Outcomes included early technical success and mortality, and late primary/secondary patency and freedom from conversion to open surgery.
Main Results:
- Technical success was achieved in 98.1% of patients, with no intraoperative or perioperative ruptures or in-hospital deaths.
- Estimated primary patency rates at 3 years were 85%, with secondary patency at 95.5%.
- No patients required conversion to open surgery during follow-up, and patency was not significantly affected by occlusion extent or revascularization type.
Conclusions:
- Endovascular reconstruction is a successful strategy for total infrarenal aorta and aorto-iliac bifurcation occlusion.
- Percutaneous and hybrid techniques yield promising 3-year patency rates, offering a viable alternative to open surgery.
Objectives:
To analyze outcomes following endovascular treatment of total occlusion of the infrarenal aorta and aorto-iliac bifurcation in a multicenter Italian registry.
Methods:
It is a multicenter, retrospective, observational cohort study. From January 2015 to December 2018, 1306 endovascular interventions for aorto-iliac occlusive disease were recorded in the vascular registry. For this analysis, only patients treated for total occlusion of the infrarenal aorta and aorto-iliac bifurcation were included. Early (<30 days) primary outcomes of interest were technical success and mortality. Late major outcomes were primary and secondary patency and freedom from conversion to open aortic surgery.
Results:
A total of 54 (4.1%) patients met the inclusion criteria. Total percutaneous revascularization was possible in 41 (75.9%) patients and hybrid (endo plus open) intervention in 13 (24.1%) patients. The kissing-stent-graft technique was used in 45 (83.3%) cases, covered endovascular reconstruction of the aortic bifurcation (CERAB) in 5 (9.2%), and a unibody endograft deployed in 4 (7.4%). Technical success was 98.1% (n = 53). There were no episodes of intraoperative or perioperative vessel rupture. Conversion to open surgery was not necessary, and there were no in-hospital deaths. The median patient follow-up time was 16 months (interquartrile range [IQR], 6-27). The estimated primary patency rate was 95.8% ± 0.03 (95% confidence interval [CI]: 85.5-98.9) at 1 year, 91.4% ± 0.05 (95% CI: 76.2-97.2) at 2 years, and 85 ± 0.08 (95% CI: 64.5-94.6) at 3 years. Cox regression analysis demonstrated that sex (hazard ratio [HR]: 0.96; 95% CI: 0.15-6.23, p = 0.963), extent of the occlusion (HR: 0.28; 95% CI: 0.05-1.46, p = 0.130), calcium score (HR: 1.88; 95% CI: 0.31-11.27, p = 0.490), or type of endovascular reconstruction (HR: 0.80; 95% CI: 0.13-5.15, p = 0.804) did not affect primary patency. Secondary patency was 95.5% ± 0.04 (95% CI: 78.4-99.2) at 3 years. No patients required late conversion to open surgical bypass.
Conclusions:
Endovascular reconstruction for total occlusion of the infrarenal aorta and aorto-iliac bifurcation was successful using a combination of percutaneous and hybrid revascularization techniques. Estimated patency rates at 3 years of follow-up are promising and are unaffected by the extent of occlusion or type of revascularization.
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