title: Emerging role of endovascular grafts in complex aortoiliac occlusive disease.
abstract: BACKGROUND
  Aortobifemoral bypass is the standard therapy for complex aortoiliac occlusive disease. The purpose of this study was to examine the use of endovascular grafts as an alternative to aortobifemoral bypass in patients with advanced aortoiliac occlusive disease at high risk.
  
  
  METHODS
  Endovascular grafts were placed in 23 limbs in 22 patients with TransAtlantic Inter-Society Consensus document (TASC) type C and D lesions. All procedures were performed in the operating room, and images were obtained with portable digital fluoroscopy. Surgical exposure of the ipsilateral common femoral artery was performed to enable safe closure of 9F to 12F sheath sites and to facilitate ipsilateral interventions in the distal external iliac artery. Concomitant infrainguinal outflow procedures were performed in 6 patients.
  
  
  RESULTS
  Twenty of 22 patients were men; mean patient age was 63.2 +/- 3.2 years. Indications for intervention were rest pain in 12 of 23 limbs and tissue loss in 9 of 22 limbs. Risk factors included hostile abdomen or pelvis in 8 patients, coronary artery disease in 11 patients, end-stage renal disease in 3 patients, and severe chronic obstructive pulmonary disease in 3 patients. Each patient received a mean of 1.6 grafts. Initial technical success was 95.2%, with one technical failure. There was no 30-day mortality. All patients experienced at least one grade improvement per Society for Vascular Surgery reporting standards. Primary patency at 24 months was 84.2% +/- 8.0%, with a limb salvage rate of 95.3% +/- 5.0%. Mean (+/- SD) ankle brachial index improved from 0.49 +/- 0.22 to 0.87 +/- 0.26 (P <.001).
  
  
  CONCLUSIONS
  Endovascular grafting to treat advanced aortoiliac occlusive disease can be accomplished with good clinical outcome and acceptable short-term patency. This endovascular technique can be a viable alternative to conventional surgical revascularization in patients with advanced aortoiliac occlusive disease at high risk.
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Ahsan T
authors.initials: AT
authors.lastname: Ali
authors.forename: J Gregory
authors.initials: JG
authors.lastname: Modrall
authors.forename: Jorge
authors.initials: J
authors.lastname: Lopez
authors.forename: John G
authors.initials: JG
authors.lastname: Brawley
authors.forename: M Burress
authors.initials: MB
authors.lastname: Welborn
authors.forename: G Patrick
authors.initials: GP
authors.lastname: Clagett
authors.forename: R James
authors.initials: RJ
authors.lastname: Valentine
authors.forename: Mark R
authors.initials: MR
authors.lastname: Jackson
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods; D001012:Aorta, Abdominal; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D002404:Catheterization / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011336:Probability; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014654:Vascular Patency