Recent Advances in Endovascular Treatment of Aortoiliac Occlusive Disease

Abstract

The rate of endovascular interventions for iliac occlusive lesions is continuously growing. The evolution of the technology supporting these therapeutic measures improves the results of these interventions. We performed a review of the literature to report and appreciate short-and long-term results of endovascular stenting of iliac artery occlusive lesions. The Medline database was searched to identify all the studies reporting iliac artery stenting for aortoiliac occlusive disease (Trans Atlantic Inter-Society Consensus [TASC] type A, B, C, and D) from January 2006 to July 2012. The outcomes were technical success, long-term primary and secondary patency rates, early mortality, and complications. Technical success was achieved in 91% to 99% of patients as reported in all the analyzed articles. Early mortality was described in 5 studies and ranged from 0.7% to 3.6%. The most common complications were access site hematomas, distal embolization, pseudoaneurysms, and iliac artery ruptures. The complications were most often treated conservatively or using percutaneous techniques. The 5-year primary and secondary patency rates ranged from 63% to 88% and 86% to 93%, respectively; and the 10-year primary patency rates ranged from 68% to 83%. In this article, combined percutaneous endovascular iliac stenting and infrainguinal surgical reconstructions and new techniques in the treatment of iliac stent restenosis are discussed. Iliac stenting is a feasible, safe, and effective method for the treatment of iliac occlusive disease. Initial technical and clinical success rates are high; early mortality and complication rates are low. Longterm patency is comparable with that after bypass surgery.

Treatment of Aortoiliac Occlusive Disease With the Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) Technique: Results of a UK Multicenter Study

“…22,23 Further studies have shown that using covered iliac stents for TASC C and D lesions is associated with favorable technical success, hence this is becoming a common technique to address AIOD. [6][7][8]10,[21][22][23][24] When using kissing stents in severe AIOD, however, the positioning of the stents and the discrepancy between the stented lumen and the aortic lumen ("radial mismatch") can have a negative impact on patency. 7,10,22 The CERAB technique aims to minimize this radial mismatch and achieve a more "anatomical" distal aortic and iliac reconstruction.…”

“…[6][7][8]10,[21][22][23][24] When using kissing stents in severe AIOD, however, the positioning of the stents and the discrepancy between the stented lumen and the aortic lumen ("radial mismatch") can have a negative impact on patency. 7,10,22 The CERAB technique aims to minimize this radial mismatch and achieve a more "anatomical" distal aortic and iliac reconstruction. 6,7,11 The CERAB procedure also moves the aortic bifurcation proximally, which mimics the mechanics of a bifurcated graft used in open aortoiliac surgery.…”

“…9 Since its publication, however, there have been very notable advances in endovascular techniques for AIOD. 6,7,10,11 Among these advances is the covered endovascular reconstruction of aortic bifurcation (CERAB) technique, devised specifically for treating complex TASC II D AIOD lesions. [6][7][8]11 The CERAB technique was designed to potentially improve the results of endovascular reconstruction.…”

Comparison of results of endovascular stenting and bypass grafting for TransAtlantic Inter-Society (TASC II) type B, C and D iliac occlusive disease

“…The majority of the intraprocedural complications of IAS can be managed conservatively. Early mortality following iliac stent implantation has been reported in several studies and ranged from 0.7% to 3.6% [ 2 , 4 , 23 ].…”

Two-Year Primary Patency Rates After Aortoiliac Occlusive Disease Endovascular Treatment

“…Computed tomographic angiography has pretermitted digital subtraction angiography in imaging (2) and endovascular therapy has become the treatment of choice for debilitating aortoiliac occlusive disease in patients complaining of lower limb claudication (3). This growing interest for percutaneous transluminal angioplasty is based on its safety, technical feasibility (4), and non-invasive nature compared with open surgery along with lower mortality and infection rates (5).…”