Mid-term results of endovascular reconstruction for aorto-iliac obstructive disease.
OBJECTIVE
Aorto-iliac obstructive disease has been traditionally treated with endarterectomy and/or a surgical bypass graft. Kissing-stents technique has been proposed to reconstruct the aorto-iliac bifurcation for complex aorto-iliac lesions.


METHODS
We report 43 patients with complex aorto-iliac occlusions managed with endovascular repair. Between March 1999 and October 2005, a total of 43 patients with a mean age of 66+/-10 years underwent endovascular treatment for aorto-iliac obstructive disease. Lesions were classified C (n=34) and D (n=9), accordingly to the Trans-Atlantic Inter-Society Consensus (TASC) classification. All endovascular interventions were performed in the theatre under regional anesthesia. Predilation with kissing-balloons angioplasty was usually performed; the bifurcation was then eventually reconstructed using bilateral stents placed with the kissing technique. Clinical examination and duplex scans or computed tomography-angiography (CT-A) were performed at discharge and 1, 6, and 12 months after the procedure, with yearly studies thereafter.


RESULTS
Kissing-stents technique was selectively used in 30 cases (69.7%); the remainder cases were treated with kissing-balloons. Major complications occurred in 2 patients (4.6%). Overall, mean hospitalization was 4.1+/-2.8 days (median 3 days). Mean follow-up was 32.4 months (range 1-84 months; median 36 months). During the follow-up, 2 patients (4.6%) died. Duplex and/or CT-A examination detected 4 re-occlusions. Primary patency rates at 12, 24, and 60 months were 92%, 85.7%, and 80.7%, respectively; overall secondary patency rate was 40/43 patients.


CONCLUSIONS
We consider this approach most appropriate for patients deemed at high operative risk for conventional repair or for those who refuse surgery.
Piffaretti
G
G
Division of Vascular Surgery, Department of Surgery, University of Insubria-Varese, Varese, Italy. gabriele.piffaretti@tiscali.it
Tozzi
M
M
Lomazzi
C
C
Rivolta
N
N
Laganà
D
D
Carrafiello
G
G
Caronno
R
R
Castelli
P
P
D000368:Aged; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon / Q000009:adverse effects; D001018:Aortic Diseases / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011150:Popliteal Artery / Q000000981:diagnostic imaging; D011474:Prosthesis Design; D015641:Radiography, Interventional; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency