Primary Stenting of Focal Atherosclerotic Infrarenal Aortic Stenoses: Long-Term Results in 13 Patients and a Literature Review

Abstract

We conducted this study to investigate the value of primary stent implantation for the endovascular treatment of focal atherosclerotic stenoses of the infrarenal abdominal aorta. The data of 13 patients with a localized complex infrarenal aortic stenosis who underwent primary stenting was retrospectively evaluated. The patients (6 females, 7 males) had a mean age of 57.3 +/- 9.1 years (mean +/- SD). In all patients, the aortic diameter was measured on CT sections, and a self-expanding endoprosthesis was primarily implanted followed by dilatation with single or double balloons. In 3 patients, additional distal stenoses were also endovascularly treated. The procedure was technically successful in all patients. No complications occurred except for 2 minor groin hematomas. During the 43 +/- 23 months (mean +/- SD) follow-up (range: 12-96 months), all stented aortic segments remained patent. Clinical patency was lost in 4 patients, which was due to atherosclerosis or restenosis distal to the aorta. In view of the excellent early and long-term results, we believe that primary stenting should be considered the first line treatment in properly selected patients with focal atherosclerotic infrarenal stenoses of the abdominal aorta.

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).…”

“…Endovascular treatment of infrarenal aortic stenosis has been proposed [28,29] as a viable alternative to surgical revascularisation since the 1980s, and data available have established the safety and effectiveness of PTA, with an 85% primary and a 90% secondary patency rate [7][8][9][10][11][12] together with a low (3%) risk of major complications, such as vessel-wall rupture and distal and visceral embolism [21]. However, most evidence concerns the treatment of focal (<20-mm) stenoses not involving the distal aortic bifurcation [21].…”

“…However, most evidence concerns the treatment of focal (<20-mm) stenoses not involving the distal aortic bifurcation [21]. On the other hand, data on aortic stenting mainly focus on its use for the management of unsuccessful or complicated PTA procedures [4, 5, 13-18, 23, 30, 31].…”

“…In letteratura, nella maggior parte delle casistiche, le indicazione allo stent sono state l'insuccesso o le complicanze della PTA, quali il ritorno elastico di parete e il flap stenosante o occludente ("secondary stenting") [4,5,[13][14][15][16][17][18][19][20][21][22]. 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].…”

“…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".…”