Outcomes of Endovascular Reconstructive Techniques in Trans-Atlantic Inter-Society Consensus II C-D Aortoiliac
Sergio Zacà1, Claudio Desantis1, Lucia Di Stefano1
1Vascular and Endovascular Surgery - Department of Emergency and Organs Transplantation (DETO), "Aldo Moro" University of Bari School of Medicine, Bari, Italy.
Insights
Endovascular reconstruction of severe aorto-iliac obstructions using advanced techniques demonstrates promising safety and mid-term patency. These methods allow for customized revascularization based on individual patient anatomy.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aorto-iliac Disease
Background:
- Severe aorto-iliac obstructions, classified as TASC C/D lesions, pose significant challenges in infrarenal aorta and aortic bifurcation treatment.
- Endovascular reconstruction offers a less invasive approach compared to open surgery for these complex lesions.
Purpose of the Study:
- To evaluate the outcomes of endovascular reconstruction for TASC C/D aorto-iliac lesions.
- To compare different endovascular techniques used for infrarenal aorta and aortic bifurcation reconstruction.
Main Methods:
- Retrospective, single-center observational study of 87 patients over a 5-year period.
- Patients underwent endovascular procedures including kissing covered stent (cKS), covered reconstruction of aortic bifurcation (CERAB), and unimodular bifurcated AFX Unibody stent-graft (Bif-SG) implantation.
- Outcomes assessed included early mortality, amputation, thrombosis, and mid-term patency, limb salvage, and reintervention rates.
Main Results:
- All 87 patients achieved technical success with no ruptures or conversions to open surgery.
- Mid-term primary patency rates were 91.2% at 1 year and 83.5% at 3 years.
- Excellent limb salvage (98.6%) and freedom from reintervention (87% at 3 years) were observed.
Conclusions:
- Advanced endovascular techniques provide safe and effective mid-term solutions for severe aorto-iliac obstructions.
- The versatility of reconstructive configurations enables tailored treatment strategies for diverse patient anatomies.
Background:
To describe the outcomes of the endovascular reconstruction of TASC C/D lesions involving the infrarenal aorta and aortic bifurcation with different techniques.
Methods:
This is an observational, retrospective, single-center study. In a 5-year period, we selected all the patients treated with an endovascular procedure for an aorto-iliac TASC C/D lesion involving the infrarenal aorta and/or the aortic bifurcation. Early (<30 days) outcomes were mortality, major amputation, and thrombosis. Late mid-term (1 and 3 years) outcomes were primary, assisted primary and secondary patency, limb salvage rate, and freedom from reintervention.
Results:
A total of 87 patients were treated during the index period. Kissing covered stent (cKS), covered reconstruction of aortic bifurcation (CERAB), and unimodular bifurcated AFX Unibody stent-graft (Bif-SG) implantation were performed in 35 (40.4%), 26 (29.8%), and 26 (29.8%) cases, respectively. Bif-SG group included 11 (11/26, 42.3%) patients treated for abdominal aortic aneurysm associated with the obstruction of the aortic bifurcation. Technical success was achieved in all cases and no ruptures or conversions to open surgery were recoded. Median follow-up age was 18 months (interquartile range [IQR], 8-34). Overall primary patency rate was 91.2% (95% confidence interval [CI]: 81.3-95.9) at 1 year and 83.5% (95% CI: 69.6-91.4) at 3 years. Assisted primary patency was 96.9% (95% CI: 87.8-99.2) at 1 and 3 years. Secondary patency was 97.8% (95% CI: 85.5-99.6) at 3 years. Limb salvage rate was 98.6% (95% CI: 90.1-99.7) at 1 and 3 years and, freedom from reintervention was 98.4% (95% CI: 88.9-99.7) at 1 year and 87% (95% CI: 66.1-95.4) at 3 years. Univariate analysis did not identify any factor affecting primary patency rate.
Conclusions:
Endovascular reconstruction in severe aorto-iliac obstructions using advanced techniques offered promising mid-term patency rates and profiles of safety. The variety of reconstructive configurations allows surgeons to customize on patients' anatomies the type of revascularization.
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