Endovascular management of chronic infrarenal aortic occlusion.
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.
Moise
Mireille A
MA
Department of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA. moisem@ccf.org
Alvarez-Tostado
Javier A
JA
Clair
Daniel G
DG
Greenberg
Roy K
RK
Lyden
Sean P
SP
Srivastava
Sunita D
SD
Eagleton
Matthew
M
Sarac
Timur S
TS
Kashyap
Vikram S
VS
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