Background
Aortoiliac arterial occlusive disease (AIOD) is one of the commonest patterns of
systemic atherosclerosis with a spectrum of chronic symptoms from intermittent
claudication to critical limb ischemia, which is a common therapeutic challenge. A
meaningful shift has evolved in treating symptomatic AIOD from open to
endovascular repair, which are becoming an attractive treatment option even in
complex lesions, especially in patients with considerable risk.
Aim
The aim of this study was to assess the feasibility, that is, technical success rates,
primary patency, and safety outcome for Trans-Atlantic Inter-Society Consensus
(TASC) D lesions treated endovascularly with analysis of outcome of stent graft
versus bare metal stent in patients with advanced Leriche syndrome.
Patients and methods
A prospective case series study: over 30 months, our case study was conducted on
22 patients with TASC D lesion morphology undergoing treatment for symptomatic
chronic AIOD at the Vascular Unit, General Surgery Department, Benha University
Hospitals, Vascular Surgery Department, Nile Insurance Hospital and Vascular
Surgery Department, Security Forces Hospital and Al-Noor Specialist Hospital,
Makkah, Saudi Arabia. The patients were enrolled from April 2015 until October
2016 with a 12-month follow-up period from the last patient enrolled. SPSS, version
20.0 for Windows was used for statistical analysis.
Results
Our study had a technical success rate of 95.5% in crossing TASC D lesion with
immediate angiographic success (91%). The 12-month primary patency rate was
85% for TASC D lesions with a target lesion revascularization of 15%. Stent grafts
had a higher 1-year patency rate (91.7%) versus bare metal stent (75%). The total
procedure-related complications rate was 18.1% and 30 days procedure-related
mortality was 4.7%.
Conclusion
Our study shows that technical success of endovascular therapy for TASC D
lesions was 95.5% with a 1-year primary patency of 85% and a complication rate of
22.7% in TASC D lesions. Utilizing more than one access with antegrade crossing
the lesion through brachial access was paramount for technical success. Long-term
follow-up is mandatory to support the durability of the procedure. |
