Long-term Results of Endovascular Treatment of TASC C and D Aortoiliac Occlusive Disease with Expanded Polytetrafluoroethylene Stent Graft

Bracale, Umberto Marcello; Giribono, Anna Maria; Spinelli, Domenico; Guercio, Luca del; Pipitò, Narayana; Ferrara, Dolores; Barillà, David; Barbarisi, Danilo; Derone, Graziana; Benedetto, Filippo

doi:10.1016/j.avsg.2018.07.060

Cited by 35 publications

(31 citation statements)

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“…Most of the recent literature has focused on evaluation of results from the treatment of complex lesions of the aortoiliac segment. [3][4][5][6]14,[25][26][27][28][29] Few large series have reported the results of iliac stenting for all TASC II lesions. [30][31][32] The present study adds to the body of knowledge and represents a recent "real-world" update of endovascular treatment options and their results in a large cohort of patients with AIOD.…”

Section: Discussionmentioning

confidence: 99%

Outcomes From the Multicenter Italian Registry on Primary Endovascular Treatment of Aortoiliac Occlusive Disease

et al. 2019

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Purpose: To report the results of endovascular treatment of iliac and complex aortoiliac occlusive disease (AIOD) in a multicenter Italian registry. Materials and Methods: A retrospective, multicenter, observational cohort study analyzed 713 patients (mean age 68±10 years; 539 men) with isolated iliac and complex aortoiliac lesions treated with primary stenting between January 2015 and December 2017. Indications for treatment were claudication in 406 (57%) patients and critical limb ischemia in 307 (43%). According to the TransAtlantic Inter-Society Consensus II (TASC) classification, the lesions were categorized as type A (104, 15%), type B (171, 24%), type C (170, 24%), and type D (268, 37%). Early (<30 days) endpoints included mortality, thrombosis, and major complications. Late major outcomes were primary and secondary patency and freedom from reintervention as estimated by Kaplan-Meier analysis; estimates are given with the 95% confidence intervals (CIs). Associations between baseline variables and primary patency were sought with multivariate analysis; the results are presented as the hazard ratio (HR) and 95% CI. Results: Technical success was achieved in 708 (99%) lesions; in-hospital mortality was 0.6% (n=4). The median follow-up was 11 months (range 0–42). The estimated primary patency rate was 96% (95% CI 94% to 97%) at 1 year and 94% (95% CI 91% to 96%) at 2 years. The estimated secondary patency was 99% (95% CI 97% to 99%) at 1 year and 98% (95% CI 95% to 99%) at 2 years. The estimated freedom from reintervention was 98% (95% CI 96% to 99%) at 1 year and 97% (95% CI 94% to 98.5%) at 2 years. Cox regression analysis demonstrated that the application of a covered stent was associated with an increased need for reintervention (HR 1.4, 95% CI 1.10 to 1.74, p=0.005). Chronic obstructive pulmonary disease was associated with decreased primary patency (HR 3.7, 95% CI 1.25 to 10.8, p=0.018). Conclusion: Endovascular intervention with primary stent placement for aortoiliac occlusive disease achieved satisfactory 2-year patency regardless of the complexity of the lesion. Almost all TASC lesions should be considered for primary endovascular intervention if suitable.

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Section: Discussionmentioning

confidence: 99%

Outcomes From the Multicenter Italian Registry on Primary Endovascular Treatment of Aortoiliac Occlusive Disease

et al. 2019

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“…Another issue of the EVT is re-occlusion of iliac arteries; however, the previous report demonstrated that limb ischemia was more common with surgical repair (67%) than the EVT (50%) in cases with UAF (Fox et al 2011). Moreover, the primary patency after stent-graft implantation was superior to that after metallic stents in iliac arteries (Bracale et al 2019). Because the dual-antiplatelet therapy at least 6 months could provide the high primary patency rate of stent grafts in iliac arteries (Bracale et al 2019), we considered that the EVT using Viabahn covered stent™ might be the appropriate treatment in the present case.…”

Section: Discussionmentioning

confidence: 97%

“…Moreover, the primary patency after stent-graft implantation was superior to that after metallic stents in iliac arteries (Bracale et al 2019). Because the dual-antiplatelet therapy at least 6 months could provide the high primary patency rate of stent grafts in iliac arteries (Bracale et al 2019), we considered that the EVT using Viabahn covered stent™ might be the appropriate treatment in the present case.…”

Section: Discussionmentioning

confidence: 98%

Endovascular treatment of ureteroarterial fistula using a covered stent, evaluated by intravascular ultrasound: a case report

Horie

Fujiwara²,

Satoyoshi³

et al. 2019

CVIR Endovasc

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Background: Ureteroarterial fistula is a rare life-threatening complication of indwelling ureteral stents. The mechanism has not yet been fully evaluated using intravascular imaging. Case presentation: An-84-year-old female was referred to our unit because of large volume pulsatile bleeding from the left ureter during routine stent exchange in the urology department. The hematuria was initially managed by rapidly exchanging for a new stent; however, the patient went into hypovolemic shock due to acute blood loss. The patient underwent implantation of the bilateral ureteral stents due to urinary retention caused by retroperitoneal fibrosis 2 years ago. To prevent ureteral infection, occlusion of the stents and stone formation, the stents were exchanged every 6 months. Computed tomography revealed contact between the left ureter and the common iliac artery. Therefore, ureteroarterial fistula was suspected and endovascular therapy was performed. Although angiography did not show definite blood flow into the ureter, a soft guidewire was advanced from the subintima of the external iliac artery to the left ureter. The diagnosis of ureteroarterial fistula was confirmed. Intravascular ultrasound identified the stent in the ureter and its connection to the subintima of the external iliac artery. The ureter did not contact directly to the inner lumen of the iliac arteries according to the ultrasound findings; therefore, we considered that the risk of stent-graft infection might not be high. After coil embolization of the ipsilateral internal iliac artery, a covered stent was implanted in the external iliac artery to seal the subintimal entry. The patient had no further episodes of any gross hematuria on dual anti-platelet therapy, when the ureteral stent was exchanged three time during 1 year after the endovascular therapy. Conclusions: We demonstrated a case of ureteroarterial fistula, in which intravascular ultrasound allowed to visualize the communication between the ureter and the subintimal lumen in the external iliac artery.

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“…17,19,20 Accordingly in our study, complex AIOD group have lower level of technical success, which is similar to many previous studies previous studies. [21][22][23] Most common reason for technical failure was inability to cross the CTO segment, including inability to break the proximal or distal cap of the occlusion and reentry. Proximal access and combine with retrograde access has been emphasized in several studies as a solution.…”

Section: Discussionmentioning

confidence: 99%

Midterm Outcomes after Primary Stenting in Treatment of Atherosclerotic Iliac Arteries

Atay

Saydam²,

Şerefli

et al. 2021

Arch Med Sci

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IntroductionThe purpose of this study was to report the midterm outcomes of primary stenting of iliac arteries with additional factors which affect the outcome and to compare the results between patients with simple and complex aorta iliac occlusive disease (AOID).Material and methodsFrom January 2015 and March 2018, the study consisted of 103 lesions in 93 patients with common iliac artery (CIA) and/or external iliac artery (EIA) lesions which accompanied with severe claudication or critical limb ischemia. Balloon-expandable stents (BMS), self-expandable stents (SES) and covered stents (CS) were used to treat the lesions.ResultsLesions of 93 patients that were in CIA and/or EIA and treated with ET were included to the study (n=103). Seventy-one (68.9%) lesions were classified as simple AIOD group (TASCII A-B) while 32(31.1%) were classified as complex AIOD (TASCII C-D) group. In 72.8% of the lesions only mild calcification was detected while 27.2% lesions had moderate or severe calcification. Mean stent diameter for CIA position was 8.26±0.8mm and for EIA position was 7.52±0.8mm. Mean lesion length in patients treated with BMS were 52.5±21.0mm while SES were 63.6±28.3(p=0.03). Technical success was achieved in 101(98.1%) lesions. Significant differences in primary (93% vs 63%) and secondary (98% vs 82%) patency rates at 24 months were found between patients in simple and complex AIOD group (p<0.001 p=0.001)ConclusionsConclusion: In our study, it was found that the primary stenting in patients who had AIOD had satisfactory results with high immediate success, low complication rates and acceptable midterm outcomes.

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Long-term Results of Endovascular Treatment of TASC C and D Aortoiliac Occlusive Disease with Expanded Polytetrafluoroethylene Stent Graft

Cited by 35 publications

References 37 publications

Outcomes From the Multicenter Italian Registry on Primary Endovascular Treatment of Aortoiliac Occlusive Disease

Outcomes From the Multicenter Italian Registry on Primary Endovascular Treatment of Aortoiliac Occlusive Disease

Endovascular treatment of ureteroarterial fistula using a covered stent, evaluated by intravascular ultrasound: a case report

Midterm Outcomes after Primary Stenting in Treatment of Atherosclerotic Iliac Arteries

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