Endovascular Reconstruction for Total Aorto-Iliac Occlusion

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.