Endovascular management of total juxtarenal aortic occlusive disease in high-risk patients: technical considerations and clinical outcome.
BACKGROUND
To report our single-center experience in the endovascular treatment of juxtarenal aorto-iliac occlusions.


METHODS
Between December 2008 and December 2012, 13 patients with total juxtarenal aorto-iliac occlusion, considered at high risk for open revascularization, were treated by endovascular means at our Department. Inclusion criteria were severe intermittent claudication, rest pain and distal tissue loss. Antegrade recanalization from percutaneous brachial access and retrograde angioplasty and stenting from percutaneous or surgical femoral accesses were performed. The renal arteries (RAs) were protected using filters or balloons. Aorto-iliac bare-metal stents were deployed in all patients.


RESULTS
No death was registered. Technical success was 100%. In 11 patients (84.6%) the Ankle-Brachial Index increased to 0.9-1. Renal arteries were involved in 7 cases (53.8%): 3 chimney stent grafts deployment, 2 aorto-iliac stent fenestrations and 2 aorto-iliac stents placement above the renal arteries without renal function impairment. Complication rate was 38.5%: 2 cases of thrombus dislodgement into the RAs, 1 distal artery embolization, 1 common iliac artery rupture and 1 pseudo-aneurysm. All complications were treated percutaneously, except for the distal embolization treated surgically. The patient with iliac artery rupture underwent acute renal insufficiency requiring temporary dialysis after hemorrhagic shock because of retroperitoneal hematoma. Mean follow-up was 18 months (range 6-30 months). The primary and secondary patency was respectively 92.3% and 100%.


CONCLUSIONS
Endovascular recanalization of juxtarenal aorto-iliac occlusion in selected patients is feasible and safe, with good early and mid-term results and should be considered in high risk patients.
Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy - n.mangialardi@sanfilipponeri.roma.it.
Nicola
N
Mangialardi
Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy.
Sonia
S
Ronchey
Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy.
Eugenia
E
Serrao
Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy.
Stefano
S
Fazzini
Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy.
Vittorio
V
Alberti
Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy.
Matteo
M
Orrico
Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy.
Holta
H
Kasemi
D000328:Adult; D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation; D055109:Ankle Brachial Index; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D007925:Leriche Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008670:Metals; D008875:Middle Aged; D012307:Risk Factors; D012384:Rome; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
D008670:Metals