title: Endovascular management of chronic infrarenal aortic occlusion.
abstract: OBJECTIVE
  To review our experience with the endovascular treatment of chronic infrarenal aortic occlusion with regard to technical success and midterm patency, as well as perioperative mortality and morbidity.
  
  
  METHODS
  A retrospective review was performed of patients who presented from January 1, 2000, to December 31, 2005, with a diagnosis of chronic infrarenal aortic occlusion (TASC D) treated with endovascular techniques. In this time period, 31 patients (22 women; mean age 63 years) underwent attempted recanalization of the occluded aorta and iliac arteries. Claudication was the most common presenting symptom (14, 45%). Patients were treated solely with angioplasty and stenting or thrombolysis followed by angioplasty/stenting based on surgeon preference.
  
  
  RESULTS
  Technical success was 93%. The 2 failures were individual cases of wire-induced iliac artery perforation and failed access; both patients were treated with bypass grafting. Nine (29%) patients had thrombolysis prior to angioplasty. There were no perioperative deaths. Postoperative ankle-brachial indexes increased significantly from preoperative values (p<0.0001). There were 3 technical complications: 1 (3%) iatrogenic iliac artery injury and 2 (6%) perioperative limb thromboses requiring intervention. Other complications included 6 (19%) access site events and 5 (16%) episodes of acute renal dysfunction, 2 requiring permanent dialysis. Over a mean follow-up of 12 months, there was no limb loss. At 1 and 3 years, the primary/secondary patency rates were 85%/100% and 66%/90%, respectively.
  
  
  CONCLUSIONS
  Endovascular therapy for chronic infrarenal aortic occlusion has a high technical success rate, with good midterm primary and secondary patency rates. However, renal dysfunction can occur; the etiology is likely multifactorial from contrast volumes, embolization, and/or renal arterial disease.
authors.affiliation: Department of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA. moisem@ccf.org
authors.forename: Mireille A
authors.initials: MA
authors.lastname: Moise
authors.forename: Javier A
authors.initials: JA
authors.lastname: Alvarez-Tostado
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Clair
authors.forename: Roy K
authors.initials: RK
authors.lastname: Greenberg
authors.forename: Sean P
authors.initials: SP
authors.lastname: Lyden
authors.forename: Sunita D
authors.initials: SD
authors.lastname: Srivastava
authors.forename: Matthew
authors.initials: M
authors.lastname: Eagleton
authors.forename: Timur S
authors.initials: TS
authors.lastname: Sarac
authors.forename: Vikram S
authors.initials: VS
authors.lastname: Kashyap
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D001027:Aortography; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency