Midterm Outcomes of Covered Versus Bare-Metal Balloon-Expandable Stents for Aortoiliac Occlusive Disease

Abstract

CTA revealed an intact surgical repair of the ascending aorta and a stable dissection across the entire aorta extending into the left common iliac artery. There was compression of the internal lumen of the left common iliac artery by the false lumen without a re-entry site at this level.After discussing with patient, we agreed to attempt an endovascular fenestration with the objective to create a distal re-entry site and subsequent equilibration of pressure gradients.Procedure: Ultrasound guided left Common Femoral access was achieved, and a 6 french sheath secured. A 0.035'' hydrophilic floppy wire was advanced into the true lumen. IVUS was used to confirm true lumen wire placement, as well as the functional collapse at the level of the common iliac artery. The wire was exchanged for a 0.014'' support wire and the Out-backÒ re-entry catheter was advanced in a retrograde fashion to approximately 4 cm above the iliac bifurcation. Utilizing the catheter's radiopaque markers/guidance system, the hollow needle was projected forward managing to perforate across the aortic flap. At that time, the wire was advanced into the false lumen and the re-entry device removed. The wire was promptly exchanged to a 0.035''support wire and multiple balloon dilatations were accomplished uneventfully to a maximum of 18 mm (Figs 1 and 2).The next morning, we encountered a symmetrical femoral pulse exam. Repeat noninvasive stress testing demonstrated an ABI > 0.99 which did not change with exercise testing. Remarkably, the patient referred that his usual symptoms had completely resolved.