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Amanvermez Senarslan D, Yildırım F, Bayram B, Kurdal AT, Tetik O. Results of endovascular treatments of Trans-Atlantic Inter-Society Consensus C or D aortoiliac occlusive disease involving the aortic bifurcation. SAGE Open Med 2023; 11:20503121231179836. [PMID: 37674557 PMCID: PMC10478553 DOI: 10.1177/20503121231179836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/17/2023] [Indexed: 09/08/2023] Open
Abstract
Objectives The current study aims to report midterm results of patients treated with endovascular intervention, kissing stent, or covered endovascular reconstruction of the aortic bifurcation, for Trans-Atlantic Inter-Society Consensus C or D aortoiliac occlusive disease involving the aortic bifurcation. Methods Eighteen patients who have intermittent claudication or chronic limb threatening ischemia with Trans-Atlantic Inter-Society Consensus C or D aortoiliac occlusive disease involving the aortic bifurcation enrolled to the study between January 2018 and January 2021. Kissing stents, Advanta V12 (Atrium, Getinge Group), were used in 13 patients, and the covered endovascular reconstruction of the aortic bifurcation technique was used in 4 patients to reconstruct the aortic bifurcation. The patients were followed for a median of 49 months (min. 2, max.58 months). Patency rates, mortality, morbidities, and reinterventions were recorded. Results The mean age of the patients was 60.4 ± 10 years. Technical success was achieved in 94.4% of the patients, but one patient had to convert to open surgery. Primary patency rate of the remaining patients was 85.6% at 58 months. Target lesion revascularization rate was 11.7%. One patient had successful reintervention for in stent restenosis, and secondary patency rate was 93.3% at 58 months. Limb salvage rate was 84.6% during the follow-up. Two patients had myocardial infarction (11.1%) and one mortality (5.6%) occurred because of cerebrovascular event in the follow-up. Conclusions Endovascular techniques can be used safely for reconstruction of the aortic bifurcation in Trans-Atlantic Inter-Society Consensus C or D aortoiliac occlusive disease in selected patients who have high risk for open surgery. Covered endovascular reconstruction of the aortic bifurcation is the only technique that showed patency rates approaching open surgery in treatment of aortoiliac occlusive disease involving the aortic bifurcation to date. Although promising patency results were achieved with kissing-covered stents, long-term patency rates were still lower than those achieved with open surgery. Further randomized controlled studies comparing the long-term results of these techniques are needed.
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Affiliation(s)
| | - Funda Yildırım
- Department of Cardiovascular Surgery, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Barıs Bayram
- Department of Cardiovascular Surgery, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Adnan Taner Kurdal
- Department of Cardiovascular Surgery, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Omer Tetik
- Department of Cardiovascular Surgery, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
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Ribeiro TF, Correia R, Bento R, Camacho N, Monteiro Castro J, Ferreira ME. Ascending aortobifemoral and adjunct carotid bypass grafts. J Vasc Surg Cases Innov Tech 2023; 9:101203. [PMID: 37635741 PMCID: PMC10448271 DOI: 10.1016/j.jvscit.2023.101203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/10/2023] [Indexed: 08/29/2023] Open
Abstract
We describe a case of simultaneous ascending aortobifemoral and right common carotid artery bypass to treat a symptomatic brachiocephalic artery and juxtarenal chronic total occlusion in a 68-year-old female patient with unfavorable characteristics for endovascular and standard aortofemoral procedures. Mid-term follow-up revealed sustained remission of symptoms, quality of life quality of life improvement, and patent bypass grafts. In highly selected patients, this solution can be useful when treating other intrathoracic diseases, as well as allowing the simultaneous revascularization of two remote arterial beds.
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Affiliation(s)
- Tiago F. Ribeiro
- Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Ricardo Correia
- Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Rita Bento
- Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Nelson Camacho
- Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - João Monteiro Castro
- Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Maria Emília Ferreira
- Serviço de Angiologia e Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
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Rouwenhorst KB, Abdelbaqy OMA, van der Veen D, van Rijswijk RE, Holewijn S, Reijnen MMPJ. Long-Term Outcomes of the Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) Technique in Patients With Aorto-Iliac Occlusive Disease. J Endovasc Ther 2023:15266028231166539. [PMID: 37114939 DOI: 10.1177/15266028231166539] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND The Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) reconstruction is an endovascular technique, developed to reconstruct the aortic bifurcation in the most optimal anatomical and physiological manner. Short-term data were promising, but long-term data are still lacking. The objective was to report the long-term outcomes of CERAB for extensive aorto-iliac occlusive disease and to identify predictors for loss of primary patency. METHODS Consecutive electively treated patients with CERAB for aorto-iliac occlusive disease in a single hospital were identified and analyzed. Baseline and procedural data and follow-up were collected at 6-weeks, 6 months, 12 months, and annually thereafter. Technical success, procedural, and 30-day complications were evaluated, as well as overall survival. Patency and freedom from target lesion revascularization rates were analyzed using Kaplan Meier curves. Uni- and multivariate analysis were performed to identify possible predictors of failure. RESULTS One hundred and sixty patients were included (79 male). Indication for treatment was intermittent claudication for 121 patients (75.6%) and 133 patients (83.1%) had a TASC-II D lesion. Technical success was obtained in 95.6% of patients and the 30-day mortality rate was 1.3%. The 5-year primary, primary-assisted, and secondary patency rates were 77.5%, 88.1%, and 95.0%, respectively, with a freedom-from clinically driven target lesion revascularization (CD-TLR) rate of 84.4%. The strongest predictor of loss of primary patency of CERAB was a previous aorto-iliac intervention (odds ratio [OR]=5.36 (95% confidence interval [CI]: 1.30; 22.07), p=0.020). In patients not previously treated in the aorto-iliac tract, 5-year primary, primary assisted, and secondary patency rates were 85.1%, 94.4%, and 96.9%, respectively. At 5-year follow-up, an improved Rutherford was found in 97.9% of patients and the freedom from major amputation rate was 100%. CONCLUSION The CERAB technique is related to good long-term outcomes, particularly in primary cases. In patients that had prior treatment for aorto-iliac occlusive disease, there were more reinterventions and therefore surveillance should likely be more intense. CLINICAL IMPACT The Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) reconstruction was designed to improve outcomes of endovascular treatment of extensive aorto-iliac occlusive disease. At 5-year follow-up clinical improvement was found in 97.9% of patients without major amputations. The 5-year overall primary, primary-assisted, and secondary patency rates were 77.5%, 88.1%, and 95.0%, respectively, with a freedom-from clinically driven target lesion revascularization rate of 84.4%. Significantly better patency rates were observed for patients that were never treated before in the target area. The data implicate that CERAB are a valid treatment option for patients with extensive aorto-iliac occlusive disease. For patients previously treated in the target area, other treatment options might be considered, or more intensive follow-up surveillance is warranted.
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Affiliation(s)
| | - Omar M A Abdelbaqy
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Vascular Surgery, Assiut University Hospital, Assiut, Egypt
| | | | - Rianne E van Rijswijk
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
- Multi-Modality Medical Imaging Group, TechMed Center, University of Twente, Enschede, The Netherlands
| | - Suzanne Holewijn
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Michel M P J Reijnen
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
- Multi-Modality Medical Imaging Group, TechMed Center, University of Twente, Enschede, The Netherlands
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Covered endovascular reconstruction of the aortic bifurcation with inferior mesenteric artery chimney (ChERAB) for the management of bilateral lower extremity tissue loss with concomitant mesenteric stenosis. J Vasc Surg Cases Innov Tech 2023; 9:101145. [PMID: 37181478 PMCID: PMC10172774 DOI: 10.1016/j.jvscit.2023.101145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/17/2023] [Indexed: 03/13/2023] Open
Abstract
Aortoiliac occlusive disease involving mesenteric branches poses an interesting challenge. Although an open surgical approach is considered the gold standard, endovascular techniques such as covered endovascular reconstruction of the aortic bifurcation with inferior mesenteric artery chimney have been presented as alternatives for patients unfit for major surgical repair. A 64-year-old man with bilateral chronic limb-threatening ischemia and severe chronic malnutrition underwent covered endovascular reconstruction of the aortic bifurcation with inferior mesenteric artery chimney due to significant intraoperative risk. We have presented the operative technique used. The intraoperative course was successful, and, postoperatively, the patient underwent successful, planned, left below-the-knee amputation and his right lower extremity wounds healed.
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Stewart S, Tallarita T, Wendt R, Beckermann J, Swartz H, Wildenberg J. Chimney graft preservation of inferior mesenteric artery during endovascular repair of aorto-iliac occlusive atherosclerotic disease. J Vasc Interv Radiol 2022; 33:861-863. [PMID: 35341962 DOI: 10.1016/j.jvir.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/02/2022] [Accepted: 03/13/2022] [Indexed: 11/30/2022] Open
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de Cort BA, Salemans PB, Fritschy WM, Pierie MEN, Lind RC. Long-Term Outcome for Covered Endovascular Reconstruction of Aortic Bifurcation for Aortoiliac Disease: A Single-Center Experience. J Endovasc Ther 2021; 28:906-913. [PMID: 34190635 DOI: 10.1177/15266028211028210] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The gold standard for the treatment of complex (TASC II C and D) atherosclerotic aortoiliac lesions is still open surgical repair. Endovascular techniques have a lower mortality and morbidity rate but this comes at the cost of worse patency rates when compared with open repair. Improved short- and mid-term results have been reported using the covered endovascular reconstruction of aortic bifurcation (CERAB) technique. The aim of this study was to report our initial experience with the CERAB technique and report long-term patency rates. MATERIALS AND METHODS All patients treated with the CERAB technique between 2012 and 2018 were prospectively registered in an institutional database and included in this study. Patient demographics, characteristics, symptoms, procedural, and follow-up details were collected and analyzed retrospectively. Perioperative complications and reinterventions were also identified. The Kaplan-Meier survival method was used to assess cumulative rates of patency. RESULTS A total of 44 patients were treated with the CERAB technique and included in this study. The majority of the treated aortoiliac occlusions were classified as complex: TASC II C (n=7; 15.9%) or TASC II D (n=25; 56.8%). Primary patency rate at 60 months was 83.3%, assisted primary patency was 90.9% and secondary patency 95%. No significant differences were found in patency rates comparing noncomplex (TASC II A and B) and complex (TASC II C and D) aortoiliac lesions. Seven patients (15.9%) required at least one additional procedure to maintain either assisted primary patency or secondary patency during follow-up. The 30-day complication rate in this series was 20.5% (n=9), of which 55.6% (n=5) were minor complications. All major 30-day complications (n=4) occurred during or directly after the CERAB procedure. Thirty-day mortality was 0%. No limb occlusions occurred within 30 days of the procedure. CONCLUSION Good long-term patency rates can be achieved with the CERAB technique to treat aortoiliac stenosis or occlusions while maintaining advantages associated with endovascular interventions. This remains true even when a CERAB is used to treat complex aortoiliac lesions. An endo-first approach to treat complex aortoiliac lesions seems viable.
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Affiliation(s)
- Boris A de Cort
- Department of Vascular Surgery, Isala, Zwolle, The Netherlands
| | - Pieter B Salemans
- Department of Vascular Surgery, Isala, Zwolle, The Netherlands.,Department of Surgery, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | | | | | - Robert C Lind
- Department of Vascular Surgery, Isala, Zwolle, The Netherlands.,Department of Thoracic and Vascular Surgery, Linköping University Hospital, Linköping, Sweden
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Saratzis A, Salem M, Sabbagh C, Abisi S, Huasen B, Egun A, Nash J, Lau PF, Chaudhuri A, Dey R, Patrone L, Malina M, Davies R, Zayed H. Treatment of Aortoiliac Occlusive Disease With the Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) Technique: Results of a UK Multicenter Study. J Endovasc Ther 2021; 28:737-745. [PMID: 34160321 DOI: 10.1177/15266028211025028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This UK multicenter study aims to report early- and medium-term results following covered endovascular reconstruction of aortic bifurcation (CERAB) for the treatment of aortoiliac occlusive disease (AIOD) in patients with chronic limb threatening ischemia (CLTI) or intermittent claudication (IC). MATERIALS AND METHODS Retrospective case analysis was performed of patients who underwent CERAB between November 1, 2012 and March 31, 2020 in 6 centers across the United Kingdom. Anatomical data, including degree of plaque calcification, were assessed using preoperative imaging. Outcome measures included mortality, perioperative complications, target lesion reintervention (TLR), and major limb amputation. Primary, assisted primary, and secondary patencies were calculated at set intervals. RESULTS A total of 116 patients underwent CERAB over the study period for the following reasons [48% presenting with CLTI (Rutherford 4-6) and 52% with IC (Rutherford 1-3)]; 82% presented had Trans-Atlantic Inter-Society Consensus (TASC) D AIOD disease. Median age was 65 years (range 42-90 years); 76% of the cohort were male. Severely calcified aortic and iliac lesions were noted in 90% and 80% of patients, respectively. Over a median follow-up of 18 months (range 1-91 months), 2 (1.7%) patients were lost to follow up. In total 5, (4.3%) patients died and 2 (1.7%) had a major amputation. Endovascular TLR was required in 14 (12.1%) patients at last follow up. Surgical TLR was performed in 4 (3.4%) patients at last follow-up. Seven (6%) patients developed an aortic/iliac stent occlusion at last follow-up. The Kaplan-Meier (KM) freedom from TLR at 1 year was 94% and KM 1-year primary patency, assisted primary patency, and secondary patency were 88%, 94%, and 98% respectively. Subanalysis found the following features were associated with need for TLR; TASC D disease (OR = 2.45, 95% CI 1.44 to 3.71), severe aortic calcification (OR = 2.01, 95% CI 1.03 to 2.20), and presence of tissue loss at baseline (OR = 1.43, 95% CI 1.01 to 4.63). CONCLUSION Perioperative (<30 days) and medium-term morbidity, mortality, and patency rates in this pragmatic cohort of patients with severe AIOD lesions show that CERAB is a valid revascularization option. A direct comparison with surgical treatments for AIOD in a randomized controlled trial is justified.
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Affiliation(s)
- Athanasios Saratzis
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, Leicestershire, UK
| | - Murtaza Salem
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Cezar Sabbagh
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, Leicestershire, UK
| | - Said Abisi
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Bella Huasen
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Ansy Egun
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Jennifer Nash
- University Hospital Hairmyres, NHS Lanarkshire, Edinburgh, UK
| | - Pui Fong Lau
- University Hospital Hairmyres, NHS Lanarkshire, Edinburgh, UK
| | | | - Ramita Dey
- Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK
| | - Lorenzo Patrone
- London North West University Healthcare NHS Trust, London, UK
| | - Martin Malina
- London North West University Healthcare NHS Trust, London, UK
| | - Robert Davies
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, Leicestershire, UK
| | - Hany Zayed
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
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Gao P, Li C, Wu X, Li G, Dong D, Qi J. Transbrachial and transfemoral approaches combined with visceral protection for the treatment of juxtarenal aortoiliac occlusive disease: Technical issues and clinical outcomes. Vascular 2021; 30:509-517. [PMID: 34112052 DOI: 10.1177/17085381211023229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of transbrachial and transfemoral approaches combined with visceral protection for the endovascular treatment of juxtarenal aortoiliac occlusive disease (AIOD) over an average 19-month follow-up period. METHODS In this retrospective analysis, all patients with juxtarenal AIOD at a single institution were reviewed from June 2015 to January 2020. Patient characteristics, angiographic results, and follow-up outcomes were retrospectively recorded. The indications for treatment were critical limb threatening ischemia in 12 patients and bilateral claudication in five patients. Percutaneous access via the left brachial artery was first obtained to recanalize the infrarenal occluded lesions. After that, femoral accesses were achieved. A 4-Fr catheter, a 4 mm balloon, or a 6-Fr 90-cm-long sheath was used to complete visceral artery protection. RESULTS A total of 17 juxtarenal AIOD patients (14 males; mean age, 63.4 ± 8.1 years) underwent endovascular treatment. The technical success rate was 100%. Complete reconstruction was achieved in 15 (88.2%) patients. The infrarenal aorta was reconstructed with kissing covered stent grafts (n = 7), kissing bare-metal stents (n = 2), covered stent grafts (n = 2), bare-metal stents (n = 1), or the off-label use of iliac limb stent grafts (n = 5). Renal embolization was found in 3 (17.6%) patients during intraoperative angiography. There was 1 (5.9%) case of distal runoff embolization after CDT and 1 (5.9%) case of left iliac artery rupture. One (5.9%) death occurred due to acute myocardial infarction 20 days after the operation. The average follow-up period was 19.3 ± 16.7 months (range, 1-54 months) in the remaining 16 cases. The renal artery patency rate was 100%. The estimated cumulative primary patency rates were 92.3% at 12 months and 59.3% at 36 months according to the Kaplan-Meier method. CONCLUSIONS Transbrachial and transfemoral approaches combined with visceral protection offer a safe and effective alternative to open revascularization for the endovascular treatment of juxtarenal AIOD.
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Affiliation(s)
- Peixian Gao
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, China
| | - Changliang Li
- Department of Hepatobiliary and Vascular Surgery, Zaozhuang Municipal Hospital, Zaozhuang, China
| | - Xuejun Wu
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, China
| | - Gang Li
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, China
| | - Dianning Dong
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, China
| | - Jiaxin Qi
- Office of Healthcare-Associated Infection Management, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, China
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Management of Extensive Aorto-Iliac Disease: A Systematic Review and Meta-Analysis of 9319 Patients. Cardiovasc Intervent Radiol 2021; 44:1518-1535. [PMID: 34279686 DOI: 10.1007/s00270-021-02785-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/22/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE Despite advances in endovascular management of aorto-iliac occlusive disease (AIOD) including covered endovascular reconstruction of aortic bifurcation (CERAB) techniques, guidelines for management of symptomatic Trans-Atlantic Inter-Society Consensus (TASC II) type C/D lesions favour open surgical revascularisation. This meta-analysis investigates outcomes in patients with TASC II C/D lesions treated with open bypass procedures (OS), standard endovascular treatments (SEV) or CERAB. METHODS Multiple databases (MEDLINE, EMBASE and the Cochrane database) were searched to identify studies reporting endovascular and open treatment of extensive AIOD. Studies were independently assessed. Outcomes reported included 30-day morbidity/mortality and patency rates. RESULTS A total of 9319 patients undergoing intervention for extensive AIOD were identified from 66 studies. Median patient age was 64 years (n = 3204) for SEV, 58 years (n = 240) for CERAB and 59 years for OS (n = 5875). Pooled meta-analysis for 30-day morbidity in patients undergoing SEV, CERAB and OS was 9, 10 and 15%, respectively. Thirty-day mortality rate was 0.79, 0 and 3% in the SEV, CERAB and OS groups, respectively. In these groups, one-year primary and secondary patency was 90, 88, 96 and 96, 97, and 97% whilst three-year primary and secondary patency was 78, 82, 93 and 93, 97, 97% respectively. Five-year primary and secondary patency was 71 and 89% for SEV and 88 and 95% for OS, respectively. CERAB data were only available to 3 years. CONCLUSIONS This meta-analysis shows that thirty-day morbidity and mortality favours endovascular techniques. Primary patency remains better with OS in both early and midterms;; however, secondary patency is comparable in all groups. These findings suggest that SEV/CERAB may be considered as an alternative to OS in higher-risk patients.
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Calik E, Borulu F, Arslan U, Kilic Y, Jalalzai I, Erkut B, Unlu Y. Extra- Anatomical bypass applications still as an alternative in progressive aortoiliac occlusive disease manegement. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_66_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Objective The covered endovascular reconstruction of the aortic bifurcation (CERAB) technique was introduced in 2009 in order to provide an anatomically and physiologically optimal endovascular reconstruction of the aortic bifurcation. Method In the current review, all available evidence on this technique was summarized. Results In vitro studies have shown a more favorable geometry of CERAB compared to kissing stents, leading to better local flow conditions. The results of CERAB are at least as good as those achieved with kissing stents in a more complex group of treated patients. The mid-term patency rates approach those of surgical reconstruction. Initial data show that the technique can also be used in combination with chimney grafts in order to preserve side branches. Conclusion CERAB has proven to be the most optimal endovascular treatment option for aorto-iliac occlusive disease with regard to geometry and flow and is related to promising clinical outcomes. Prospective and comparative trials are necessary to elucidate the most optimal treatment algorithm for patients with aorto-iliac occlusive disease.
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Affiliation(s)
- Michel MPJ Reijnen
- Department of Surgery, Rijnstate, Arnhem and the Multi-Modality Medical Imaging Group, University of Twente, Enschede, The Netherlands
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Bath J, Rahimi M, Leite JO, Pierre-Louis W, Giglia JS. Laparoscopic aortobifemoral bypass in a USA academic center. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 61:332-339. [PMID: 30417632 DOI: 10.23736/s0021-9509.18.10582-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although aortoiliac occlusive disease (AIOD) is preferentially treated endovascularly, some patients are still better served with an aortobifemoral bypass (ABF). For those patients, surgical treatment options include both standard open operations as well as laparoscopic ABF (LapABF). Several European centers perform LapABF with favorable results instead of open surgery, but this has not been widely embraced in the United States. We reviewed our ten-year experience with LapABF, evolving from a completely laparoscopic to a standardized laparoscopic-assisted approach. METHODS A retrospective review of all laparoscopic aortic operations performed at a single US academic institution from 2005 to 2015 was completed. Demographics, co-morbidities, intraoperative parameters and clinical outcomes were recorded. Patients were excluded from consideration for laparoscopic surgery if they had previous aortic surgery, aneurysmal disease or gastrointestinal pathology (e.g. diverticulitis or an enteric stoma). RESULTS Thirty men and sixteen women were treated, (n=46) with a mean age of 55.7 (range 38-75 years). All operations were performed by a single surgeon. LapABF was successfully completed in 95.6%. A completely laparoscopic approach was undertaken in eight patients and a laparoscopic-assisted approach was used in the remaining 38 patients. Mean follow-up was 46 months (range 1 to 131). The indication for operation was claudication (n=35, 76%), rest pain (n=8, 17%) or tissue loss (n=3, 7%). Twenty-one limbs had a history of a prior failed aortoiliac endovascular intervention (23%). Median length of stay was 6 days (range 2-30). Within 30 days there were two myocardial infarctions (4.3%), one transient ischemic attack (2.2%) and one death (2.2%). Re-intervention was performed in 12 patients over the course of the study period (26.1%). Primary, primary-assisted and secondary patency was 79.4%, 93.9% and 94.9% at 60 months, respectively. Overall mortality was 17% with a mean duration of follow-up of 60 months (range 1-116). Multivariable analysis revealed coronary artery disease (CAD; P=0.03) conferred a sixteen-fold risk for death during long-term follow-up. CONCLUSIONS In this large US series of LapABF, we observed acceptable long-term patency, short length of stay and minimal morbidity. We suggest that this standardized approach for laparoscopic-assisted ABF is a viable option for patients with AIOD not suitable for endovascular therapy. The use of laparoscopic-assisted ABF affords practitioners the benefits of a completely laparoscopic approach while reducing the duration and complexity of the operation. Given the rate of re-interventions in the early era practitioners should be aware of the learning curve with this approach.
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Affiliation(s)
- Jonathan Bath
- Division of Vascular Surgery, Department of Surgery, University of Missouri Hospitals and Clinics, Columbia, MO, USA
| | - Maham Rahimi
- Division of Vascular Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Jose O Leite
- Division of Vascular Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | - Joseph S Giglia
- Division of Vascular Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA -
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Vértes M, Juhász IZ, Nguyen TD, Veres DS, Hüttl A, Nemes B, Hüttl K, Dósa E. Stent Protrusion >20 mm Into the Aorta: A New Predictor for Restenosis After Kissing Stent Reconstruction of the Aortoiliac Bifurcation. J Endovasc Ther 2018; 25:632-639. [DOI: 10.1177/1526602818794959] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To determine the long-term patency of aortoiliac kissing stents and to identify predisposing factors for the development of in-stent restenosis (ISR). Methods: A retrospective analysis was conducted of 105 patients (median age 60.9 years; 64 women) with symptomatic aortoiliac occlusive disease who had kissing stents implanted between 2001 and 2015. The indication for kissing stents was severe claudication in 91 (86.7%) patients and critical limb ischemia in 14 (13.3%). Lesions were TASC A in 52 (49.5%), B in 29 (27.6%), C in 4 (3.8%), and D in 20 (19%) patients. Twenty-five (23.8%) patients had heavily calcified lesions. In all, 210 stents were deployed [180 (85.7%) self-expanding and 30 (14.3%) balloon-expandable]. Follow-up included clinical evaluation, ankle-brachial index measurement, and duplex ultrasonography. Results: The median follow-up was 45 months. The primary patency rates were 93%, 86%, and 77% at 12, 24, and 60 months, respectively. Significant ISR developed in 23 (21.9%) patients (12 unilateral and 11 bilateral). Univariate Cox regression analysis revealed older age [hazard ratio (HR) 0.5, 95% confidence interval (CI) 0.31 to 0.81, p=0.004] and larger aortic diameter (HR 0.42, 95% CI 0.25 to 0.7, p<0.001) to be variables favoring long-term patency, while a longer aortic stent segment (HR 1.56, 95% CI 1.16 to 2.09, p=0.003) and a larger discrepancy between the summed stent diameters and the aortic diameter (HR 1.64, 95% CI 1.01 to 2.65, p=0.043) were associated with ISR development. Multivariate analysis showed a longer aortic stent segment to be the only significant determinant of ISR (HR 1.44, 95% CI 1.02 to 2.01, p=0.035). Conclusion: The kissing stent technique can be performed with good long-term patency. Patients whose iliac stents protrude too far into the aorta need closer follow-up.
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Affiliation(s)
- Miklós Vértes
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | | | - Tin Dat Nguyen
- Medical Faculty, Semmelweis University, Budapest, Hungary
| | - Dániel Sándor Veres
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Artúr Hüttl
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Balázs Nemes
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Kálmán Hüttl
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Edit Dósa
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
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14
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Three-year outcome of the covered endovascular reconstruction of the aortic bifurcation technique for aortoiliac occlusive disease. J Vasc Surg 2018; 67:1438-1447. [DOI: 10.1016/j.jvs.2017.09.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 09/01/2017] [Indexed: 11/17/2022]
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15
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Sirignano P, Mansour W, Capoccia L, Pranteda C, Montelione N, Speziale F. Results of AFX Unibody Stent-Graft Implantation in Patients With TASC D Aortoiliac Lesions and Coexistent Abdominal Aortic Aneurysms. J Endovasc Ther 2017; 24:846-851. [DOI: 10.1177/1526602817730840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Pasqualino Sirignano
- Vascular and Endovascular Surgery Unit, Department of Surgery “P Stefanini”, Policlinico “Umberto I,” “Sapienza” University of Rome, Italy
| | - Wassim Mansour
- Vascular and Endovascular Surgery Unit, Department of Surgery “P Stefanini”, Policlinico “Umberto I,” “Sapienza” University of Rome, Italy
| | - Laura Capoccia
- Vascular and Endovascular Surgery Unit, Department of Surgery “P Stefanini”, Policlinico “Umberto I,” “Sapienza” University of Rome, Italy
| | - Chiara Pranteda
- Vascular and Endovascular Surgery Unit, Department of Surgery “P Stefanini”, Policlinico “Umberto I,” “Sapienza” University of Rome, Italy
| | - Nunzio Montelione
- Vascular and Endovascular Surgery Unit, Department of Surgery “P Stefanini”, Policlinico “Umberto I,” “Sapienza” University of Rome, Italy
- Division of Vascular Surgery, University of Campus Bio-Medico, Rome, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Unit, Department of Surgery “P Stefanini”, Policlinico “Umberto I,” “Sapienza” University of Rome, Italy
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16
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Holden A, Merrilees S, Buckley B, Connor B, Colgan F, Hill A. First-in-Human Experience With the Gore Balloon-Expandable Covered Endoprosthesis in Iliac Artery Occlusive Disease. J Endovasc Ther 2016; 24:11-18. [DOI: 10.1177/1526602816680570] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To report the first-in-human iliac artery experience of a new balloon-expandable covered endoprosthesis. Methods: A prospective, single-center pilot study recruited 30 symptomatic patients (mean age 64 years; 18 men) to evaluate the safety and early efficacy of the new Gore balloon-expandable covered endoprosthesis for the treatment of de novo or restenotic common and/or external iliac artery lesions. According to protocol, up to 2 discrete lesions could be treated with a maximum total treated length ≤110 mm. Follow-up included clinical evaluation with duplex ultrasound at 1, 6, and 12 months. Data are presented through 12-month follow-up. The primary safety endpoint was a composite of device- or procedure-related death, myocardial infarction, or amputation in the treated leg within 30 days of the index procedure. Multiple performance outcomes were also evaluated. Results: The primary 30-day safety endpoint was 0%. Per-subject estimates of primary patency, freedom from target lesion revascularization, and freedom from target vessel revascularization were 100% at 1 and 6 months and 96.6% at 12 months. Estimates of assisted primary and secondary patency were both 100% at 12 months. Freedom from major adverse events at 12 months was 100%. Most patients experienced improvements in Rutherford category, ankle-brachial index, and functional status that were sustained to 12 months. Conclusion: This positive first-in-human experience with the Gore balloon-expandable covered endoprosthesis suggests this device will have an important role in the management of aortoiliac occlusive disease.
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Affiliation(s)
- Andrew Holden
- Department of Interventional Radiology, Auckland Hospital, Auckland, New Zealand
| | - Stephen Merrilees
- Department of Interventional Radiology, Auckland Hospital, Auckland, New Zealand
| | - Brendan Buckley
- Department of Interventional Radiology, Auckland Hospital, Auckland, New Zealand
| | - Brigid Connor
- Department of Interventional Radiology, Auckland Hospital, Auckland, New Zealand
| | - Frances Colgan
- Department of Interventional Radiology, Auckland Hospital, Auckland, New Zealand
| | - Andrew Hill
- Department of Vascular Surgery, Auckland Hospital, Auckland, New Zealand
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17
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de Donato G, Setacci C. Commentary: Endovascular Reconstruction of Infra- and Juxtarenal Aortic Occlusion: Is it Prime Time for Normal-Risk Patients? J Endovasc Ther 2016; 24:25-26. [PMID: 27742899 DOI: 10.1177/1526602816673934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gianmarco de Donato
- 1 Department of Medicine, Surgery and Neuroscience, Vascular Surgery Unit University of Siena, Italy
| | - Carlo Setacci
- 1 Department of Medicine, Surgery and Neuroscience, Vascular Surgery Unit University of Siena, Italy
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