Infrarenal aortic stents: Initial clinical experience and angiographic follow-up

Abstract

From March 1990 to May 1991, arterial stents were placed in seven patients because of a tight stenosis (five patients) or a total chronic occlusion (two patients) located in the infrarenal aorta. In one case, the aortic occlusion extended to both common iliac arteries. After balloon dilatation, aortic stents were successfully positioned in all cases. Bilateral common iliac recanalization and stent placement were performed in one case. No complications occurred in any of the patients. No complications occurred in any of the patients. Follow-up data were derived from clinical assessments and angiographic results. After a 15.1-month mean follow-up period (range 12-24 months), the seven aortic stents remained patent. Three iliac artery procedures were performed in two of the patients as well. Claudication recurred in three of the seven patients which was related to a common iliac occlusion (one case) or distal progression of atherosclerosis (two cases). Aortic stents seem to be suitable for treating failed angioplasty of aortic lesions but the procedure remains technically difficult when there is associated severe atherosclerosis of the proximal common iliac arteries. Nevertheless, considering the morbidity rate (0%) and the patency rate in this series, this technique could become an alternative to surgical treatment for infrarenal aortic occlusive lesions.

Endovascular treatment of steno-occlusions of the infrarenal abdominal aorta

“…Moreover, stent deployment without predilation (direct stenting), as applied in the present study and in several other studies, reduces the risk of distal embolism of atherothrombotic debris [19][20][21][22][23][24][25][26][27]. In addition, the radial force of the stainless steel stent provides a more uniform and symmetric dilation of the vessel 3b).…”

“…Primary or direct stenting of around 100 cases of aortic disease (75% with focal stenoses) has been reported, with a 96% clinical success rate -defined as resolution or improvement in symptoms and in final haemodynamic result -and 90% primary and 100% secondary patency rates [4,13,[19][20][21][22][23][24][25][26][27].…”

“…Lo stenting, primario o diretto, è stato proposto alla luce dei favorevoli risultati ottenuti a livello iliaco con maggiori tassi di pervietà rispetto alla sola PTA [6,32] ed è stato utilizzato di prima intenzione nelle lesioni stenosanti complesse (placche ulcerate, eccentriche, irregolari e/o calcifiche) [4,13,[17][18][19][20][21][22][23][24][25][26][27] e più raramente nelle occlusioni complete [20,[23][24][25][26].…”

“…Among the causes of late clinical failure, with recurzione distale [19][20][21][22][23][24][25][26][27]. Inoltre, la forza radiale dello stent in acciaio medicale consente una dilatazione uniforme e simmetrica della parete arteriosa, anche in vasi calcifici, evitando, soprattutto in caso di lesioni eccentriche, che la dilatazione interessi solo la porzione sana della parete.…”

“…Successivamente sono stati pubblicati dati più limitati e contraddittori relativi al "primary stenting" o al "direct stenting" (stenting rispettivamente con o senza pre-dilatazione) nel trattamento endovascolare delle lesioni focali [4,13,[17][18][19][20][21][22][23][24][25][26][27], e al trattamento delle occlusioni complete dell'aorta sottorenale [22][23][24][25][26] e delle lesioni aorto-iliache [20,23,26,27]. Scopo di questo lavoro è presentare la nostra esperienza nel trattamento endovascolare della malattia stenoocclusiva dell'aorta sottorenale mediante "direct stenting".…”