Skip to main content

Advertisement

Log in

Mid-term clinical outcome following endovascular therapy in patients with chronic aortic occlusion

  • Original Article
  • Published:
Cardiovascular Intervention and Therapeutics Aims and scope Submit manuscript

Abstract

Although endovascular therapy (EVT) has been widely used for iliac lesions due to acceptable patency with stenting, EVT has not been established as primary treatment for aortic occlusion, partly because of uncertainty regarding long-term results. The purpose of this study was to investigate outcomes following EVT with stenting for chronic aortic occlusion. This study was a single-center retrospective analysis of a prospectively maintained database. Between September 2005 and May 2012, twenty-four lesions from 25 patients with a clinical diagnosis of chronic aortic occlusion (mean age, 71 years; 80 % male) were treated with EVT with stenting. Kaplan–Meier estimators were used to determine the patency rates according to Society for Vascular Surgery criteria. In results, lesion type was Trans Atlantic Inter-Society Consensus D in all patients. Mean lesion length was 145 mm. Initial success rate and procedural complication rate were 96 % (24/25) and 8 % (2/25), respectively. At 36 months, primary and secondary patency rates were 76 and 94 %, respectively. Restenosis was observed in 5 patients, all of whom underwent reintervention (four successful, one failure and intensity of medical treatment). EVT can be safely done in patients with chronic aortic occlusion. Procedural morbidity and mid-term durability were comparable to those of bypass surgery up to 3 years.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Leriche R, Morel A. The syndrome of thrombotic obliteration of the aortic bifurcation. Ann Surg. 1948;127:193–206.

    Article  PubMed  CAS  Google Scholar 

  2. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Hariss KA, Fowkes FG. TASC II Working Group Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg 2007;45(Suppl S):S5–S67.

    Google Scholar 

  3. Leville CD, Kashyap VS, Clair DG, Bena JF, Lyden SP, Greenberg RK, et al. Endovascular management of iliac artery occlusions: extending treatment to TransAtlantic Inter-Society Consensus class C and D patients. J Vasc Surg. 2006;33:32–9.

    Article  Google Scholar 

  4. Tsetis D, Uberoi R. Quality improvement guidelines for endovascular treatment of iliac artery occlusive disease. Cardiovasc Intervent Radiol. 2008;31:238–45.

    Article  PubMed  Google Scholar 

  5. Pulli R, Dorigo W, Fargion A, Innocenti AA, Pratesi G, Marek J, et al. Early and long-term comparison of endovascular treatment of iliac artery occlusions and stenosis. J Vasc Surg. 2011;53:92–8.

    Article  PubMed  Google Scholar 

  6. Scheinert D, Schroder M, Balzer J, Steinkamp H, Biamino G. Stent-supported reconstruction of the aortoiliac bifurcation with the kissing balloon technique. Circulation. 1999;100:295–300.

    Article  Google Scholar 

  7. Nyman U, Uher P, Lindh M, Lindblad B, Ivancev K. Primary stenting in infrarenal aortic occlusive disease. Cardiovasc Intervent Radiol. 2000;23:97–108.

    Article  PubMed  CAS  Google Scholar 

  8. Rosset E, Malikov S, Magnan PE, Poirier M, Valerio N, Ede B, et al. Endovascular treatment of occlusive lesions in the distal aorta: mid-term results in a series of 31 consecutive patients. Ann Vasc Surg. 2001;15:140–7.

    Article  PubMed  CAS  Google Scholar 

  9. Yilmaz S, Sindel T, Golbasi I, Turkay C, Mete A, Luleci E. Aortoiliac kissing stents: long-term results and analysis of risk factors affecting patency. J Endovasc Ther. 2006;13:291–301.

    Article  PubMed  Google Scholar 

  10. Klonaris C, Katsargyris A, Tsekoulaos N, Alexandrou A, Giannopoulos A, Bastounis E. Primary stenting for aortic lesions: from single stenoses to total aortoiliac occlusions. J Vasc Surg. 2008;47:310–7.

    Article  PubMed  Google Scholar 

  11. Bjorses K, Ivancev K, Riva L, Manjer J, Uher P, Resch T. Kissing stents in the aortic bifurcation—a valid reconstruction for aorto-iliac occlusive disease. Eur J Vasc Endovasc Surg. 2008;36:424–31.

    Article  PubMed  CAS  Google Scholar 

  12. Krankenberg H, Schuluter M, Schwencke C, Walter D, Pascotto A, Sandstede J, et al. Endovascular reconstruction of the aortic bifurcation in patients with Leriche syndrome. Clin Res Cardiol. 2009;98:657–64.

    Article  PubMed  Google Scholar 

  13. Sharafuddin MJ, Hoballah JJ, Kresowik TF, Sharp WJ, Golzarian J, Corson JD, et al. Long-term outcome following stent reconstruction of the aortic bifurcation and the role of geometric determinants. Ann Vasc Surg. 2008;22:346–57.

    Article  PubMed  Google Scholar 

  14. Moise MA, Alvarez-Tostado JA, Clair DG, Greenberg RK, Lyden SP, Kashyap VS, et al. Endovascular management of chronic infrarenal aortic occlusion. J Endovasc Ther. 2009;16:84–92.

    Article  PubMed  Google Scholar 

  15. Jongkind V, Akkersdijk G, Yeung K, Wisselink W. A systemic review of endovascular treatment of extensive aortoiliac occlusive disease. J Vasc Surg. 2010;52:1376–83.

    Article  PubMed  Google Scholar 

  16. Kim T, Ko Y, Kim U, Kim J, Choi D, Hong M, et al. Outcomes of endovascular treatment of chronic total occlusion of the infrarenal aorta. J Vasc Surg. 2011;53:1542–9.

    Article  PubMed  Google Scholar 

  17. Kashyap VS, Pavkov ML, Bena JF, Sarac TP, Lyden SP, Clair DG, et al. The management of severe aortoiliac occlusive disease: endovascular therapy rivals open reconstruction. J Vasc Surg. 2008;48:1451–7.

    Article  PubMed  Google Scholar 

  18. Hans SS, Desantis D, Siddiqui R, Khoury M. Results of endovascular therapy and aortobifemoral grafting for Transatlantic Inter-society type C and D aortoiliac occlusive disease. Surgery. 2008;144:583–90.

    Article  PubMed  Google Scholar 

  19. Burke CR, Henke PK, Hernandez R, Rectenwald JE, Krishnamurthy V, Englesbe MJ, et al. A contemporary comparison of aortofemoral bypass and aortoiliac stenting in the treatment of aortoiliac occlusive disease. Ann Vasc Surg. 2010;24:4–13.

    Article  PubMed  Google Scholar 

  20. Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997;26:517–38.

    Article  PubMed  CAS  Google Scholar 

  21. Fontcuberta J, Flores A, Langsfeld M, Orgaz A, Cuena R, Criado E, et al. Screening algorithm for aortoiliac occlusive disease using duplex ultrasonography-acquired velocity spectra from the distal external iliac artery. Vascular. 2005;13:164–72.

    PubMed  Google Scholar 

  22. Shaalan WE, French-Sherry E, Castilla M, Lozanski L, Bassiouny HS. Reliability of common femoral artery hemodynamics in assessing the severity of aortoiliac inflow disease. J Vasc Surg. 2003;37:960–9.

    Article  PubMed  Google Scholar 

  23. Spronk S, den Hoed PT, de Jonge LC, van Dijk LC, Pattynama PM. Value of the duplex waveform at the common femoral artery for diagnosing obstructive aortoiliac disease. J Vasc Surg. 2005;42:236–42.

    Article  PubMed  Google Scholar 

  24. De Vries SO, Hunink MGM. Results of aortic bifurcation grafts for aortoiliac occlusive disease: a meta-analysis. J Vasc Surg. 1997;26:558–69.

    Article  PubMed  Google Scholar 

  25. Martin D, Katz SG. Axillofemoral bypass for aortoiliac occlusive disease. Am J Surg. 2000;180:100–3.

    Article  PubMed  CAS  Google Scholar 

  26. Hertzer NR, Bena JF, Karafa MT. A personal experience with direct reconstruction and extra-anatomic bypass for aortoiliofemoral occlusive disease. J Vasc Surg. 2007;45:527–35.

    Article  PubMed  Google Scholar 

  27. West CA Jr, Johnson LW, Doucet L, Caldito G, Heldman M, Carson S, et al. A contemporary experience of open aortic reconstruction in patients with chronic atherosclerotic occlusion of the abdominal aorta. J Vasc Surg. 2010;52:1164–72.

    Article  PubMed  Google Scholar 

  28. Sabri SS, Choudhri A, Orgera G, Arslan B, Turba UC, Harthun NL, et al. Outcomes of covered kissing stent placement compared with bare metal stent placement in the treatment of atherosclerotic occlusive disease at the aortic bifurcation. J Vasc Interv Radiol. 2010;21:995–1003.

    Article  PubMed  Google Scholar 

  29. Mwipatayi BP, Thomas S, Wong J, Temple S, Vijayan V, Jackson M, et al. A comparison of covered vs bare expandable stents for the treatment of aortoiliac occlusive disease. J Vasc Surg. 2011;54:1561–70.

    Article  PubMed  Google Scholar 

  30. Mii S, Eguchi D. Comparison of axillobifemoral and aortobifemoral bypass for aorto-bilateral iliac occlusive disease. Jpn J Vasc Surg. 2005;14:7–12.

    Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tomoharu Dohi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dohi, T., Iida, O., Okamoto, S. et al. Mid-term clinical outcome following endovascular therapy in patients with chronic aortic occlusion. Cardiovasc Interv and Ther 28, 327–332 (2013). https://doi.org/10.1007/s12928-013-0173-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12928-013-0173-0

Keywords

Navigation