Endovascular treatment strategies in aortoiliac occlusion.
The aim of this study was to report our experience in endovascular treatment of total aortoiliac occlusion. Five patients who underwent endovascular recanalization procedures including manual aspiration thrombectomy, balloon angioplasty, and stent placement for total aortoiliac occlusion in a 4-year period were reviewed retrospectively. The mean age of patients was 51 years (range, 43 to 58 years). All patients had abdominal aorta and bilateral common iliac artery occlusion with or without external iliac artery occlusion. All patients either had a contraindication to surgery or refused it. Initial technical success was obtained in four of five (80%) patients. Endovascular techniques were successful in four patients who had good distal runoff and short-segment aortoiliac occlusion, but failed in a patient who had the worst distal runoff and long-segment aortoiliac occlusion. We observed two major complications, one of which was bilateral rupture of the common iliac arteries treated with covered stent placement. Another patient had extension of intra-aortic thrombus into the iliac stent after primary stenting. This was successfully treated with manual aspiration thrombectomy. Aortic and iliac stents remained patent during the follow-up period (median, 18 months; range, 3 to 26 months) in four patients. Primary patency rates at 6, 12, and 24 months were all 80%. In conclusion, endovascular treatment can be an alternative for aortoiliac occlusion in selected patients. Short- to midterm follow-up so far is satisfactory. Removal of intra-aortic thrombus with manual aspiration thrombectomy before balloon angioplasty and/or stenting is possible and a good alternative to thrombolysis.
Ozkan
Ugur
U
Department of Radiology, Baskent University Faculty of Medicine, Ankara, Turkey. radugur@yahoo.com
Oguzkurt
Levent
L
Tercan
Fahri
F
Gumus
Burcak
B
D000328:Adult; D000800:Angioplasty, Balloon; D001012:Aorta, Abdominal; D001018:Aortic Diseases / Q000628:therapy*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000628:therapy*; D015897:Comorbidity; D003287:Contrast Media; D006801:Humans; D007083:Iliac Artery; D015993:Life Tables; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D017131:Thrombectomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014654:Vascular Patency
D003287:Contrast Media