Endovascular reconstruction of the aortic bifurcation in patients with Leriche syndrome.
BACKGROUND
The Leriche syndrome with contiguous total occlusions of the infrarenal aorta and the iliac arteries is a variant of Trans-Atlantic Inter-Society Consensus (TASC) type D aortoiliac disease, for which surgery is the recommended treatment of choice. We sought to prospectively assess the feasibility and safety of an endovascular therapeutic approach.


METHODS
Eleven consecutive patients with Leriche syndrome (eight men; 64 +/- 12 years) constituted the study cohort. The treatment strategy consisted of recanalization by transbrachial access of the occluded segments and subsequent transfemoral angioplasty with selective stent placement in the distal aorta and primary nitinol stent placement in the iliac arteries.


RESULTS
Bilateral endovascular success was achieved in eight patients (73%), unilateral success in the other three patients. Seven patients received aortic stents; the total stented segment length in 19 iliac arteries successfully recanalized amounted to a median of 18 cm (range 12-26 cm). There was one periprocedural complication, an acute thrombotic aortoiliac occlusion managed by thrombolysis. One patient with unilateral endovascular success had to undergo femorofemoral crossover bypass grafting. At a median of 14 months, significant hemodynamic improvement was observed in successfully revascularized legs (ankle-brachial index, 0.79 +/- 0.20 vs. 0.48 +/- 0.08 at baseline; P = 0.0004); walking capacity as well as Rutherford category of peripheral arterial disease had improved in all patients.


CONCLUSIONS
In this small series of patients with Leriche syndrome, the reconstruction of the totally occluded aortoiliac bifurcation by endoluminal means was shown to be feasible and safe and associated with excellent mid-term clinical outcomes.
Krankenberg
Hans
H
Medical Care Center Prof. Mathey, Prof. Schofer, Wördemanns Weg 25-27, Hamburg, Germany. krankenberg@herz-hh.de
Schlüter
Michael
M
Schwencke
Carsten
C
Walter
Dirk
D
Pascotto
Andrea
A
Sandstede
Jörn
J
Tübler
Thilo
T
D000368:Aged; D000497:Alloys; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D001012:Aorta, Abdominal / Q000473:pathology / Q000503:physiopathology; D001027:Aortography; D005240:Feasibility Studies; D006439:Hemodynamics; D006801:Humans; D007083:Iliac Artery / Q000473:pathology / Q000503:physiopathology; D007925:Leriche Syndrome / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D000497:Alloys; C013616:nitinol
Circulation. 1999 Nov 9;100(19 Suppl):II295-300
10567319
AJR Am J Roentgenol. 1985 Jun;144(6):1285-6
3159240
Radiology. 1980 Feb;134(2):359-60
7352213
Arch Surg. 1959 Sep;79:487-92
13806076
Indiana Med. 1985 Apr;78(4):288-9
3158695
Lancet. 2005 Jun 25-Jul 1;365(9478):2179-86
15978925
J Vasc Surg. 1997 Feb;25(2):365-79
9052572
Circulation. 2007 Jul 17;116(3):285-92
17592075
J Vasc Surg. 2007 Jan;45 Suppl S:S5-67
17223489
Mem Acad Chir (Paris). 1947 May 28-June 4;73(18-19):409-11
18902006
Angiology. 1997 Jul;48(7):637-42
9242162
Mem Acad Chir (Paris). 1951 Jun 6-13;77(20-21):642-4
14863062
Radiology. 1997 Jul;204(1):87-96
9205227
Lyon Chir. 1956;52:402-11
13386396
AMA Arch Surg. 1959 Jul;79(1):85-93
13660605
Clin Res Cardiol. 2007 Apr;96(4):240-2
17361349
J Vasc Surg. 2006 Jan;43(1):32-9
16414384
Radiology. 2004 Apr;231(1):243-9
15068949
J La State Med Soc. 1979 Oct;131(10):263-5
521671
Vasa. 1996;25(2):180-3
8659222