Transbrachial and femoral artery approach endovascular therapy for flush infrarenal aortic occlusion.
OBJECTIVE
The purpose of this study is to report the efficacy of transbrachial and femoral artery approach endovascular therapy with catheter-directed thrombolysis (CDT) and adjunctive therapy for flush infrarenal aortic occlusion (FIAO).


METHODS
From March 2012 to December 2013, 11 consecutive patients (9 males; mean age 68 years; range 54-80 years) were submitted to endovascular therapy for FIAO. All patients were treated with CDT initially and then adjunctive endovascular treatments were performed to correct the underlying lesions.


RESULTS
Complete reconstruction of occluded aortoiliac arteries was successfully achieved in 81.8% (9/11) of patients. Left brachial and bilateral femoral arterial accesses were obtained in nine patients, and brachial and unilateral femoral in two patients. The residual lesions after CDT were corrected in nine patients and concomitant endovascular recanalization of superficial femoral artery was performed in two patients. Self-expandable stents were implanted in the all aortoiliac lesions with pre- and post-dilation. No renal or distal runoff embolization was seen during intraoperative angiography. Seven (7/9) patients with rest pain or tissue loss showed significant improvements in symptoms and two (2/9) patients with intermittent claudication gained an improved walking distance. The ABI rose significantly between pre- and post-procedure (0.84 ± 0.18 vs. 0.44 ± 0.13 on the right leg, p < .01; 0.89 ± 0.23 vs. 0.48 ± 0.16 on the left, p < .01).


CONCLUSIONS
Transbrachial and femoral artery approach endovascular therapy for FIAO offers an alternative to surgical reconstruction with immediate outcomes.
Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, PR China.
L
L
Yuan
Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, PR China. Electronic address: xueguankyb@163.com.
J
J
Bao
Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, PR China.
Z
Z
Zhao
Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, PR China.
X
X
Feng
Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, PR China.
Q
Q
Lu
Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, PR China. Electronic address: xueguankyy@163.com.
Z
Z
Jing
D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D055109:Ankle Brachial Index; D001916:Brachial Artery / Q000000981:diagnostic imaging; D057510:Endovascular Procedures / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking
Catheter-directed thrombolysis; Endovascular therapy; Flush infrarenal aortic occlusion