Treatment of Aortoiliac Occlusive Disease with the Endologix AFX Unibody Endograft

Maldonado, Thomas S.; Westin, Gregory G.; Jazaeri, Omid; Mewissen, Mark W.; Reijnen, Michel M.P.J.; Dwivedi, Amit J.; Garrett, H. Edward; Perera, Anton Dias; Shimshak, Tom; Mantese, Vito A.; Smolock, Christopher J.; Arthurs, Zachary M.

doi:10.1016/j.ejvs.2016.04.003

Cited by 58 publications

(50 citation statements)

References 29 publications

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“…Off-label use of endovascular aortic stent grafts for abdominal aortic aneurysms to treat severe AIOD was not included in this review; however, they are of interest because of their promising results. 41,42 Clinical trial populations mainly comprised patients with mild to moderate AIOD and relatively straightforward lesions, mostly owing to study design for regulatory approval. The two recent Viabahn VBX studies excluded any patients with lesions requiring atherectomy or laser ablation.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of covered balloon-expandable stents for treating aortoiliac occlusive disease

Mwipatayi

Ouriel²,

Anwari

et al. 2020

Journal of Vascular Surgery

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Objective: To evaluate and compare studies reporting the outcomes of the use of covered balloon-expandable (CBE) stents for the treatment of aortoiliac occlusive disease. Methods: A systematic literature search was conducted to identify studies that investigated the use of CBE stents for the treatment of aortoiliac occlusive disease and were published between 2000 and 2019. Baseline demographic data, procedural variables, and long-term outcomes were extracted from publications for analysis. Results: A total of 15 published articles about 14 studies were included in the review. Of these, eight studies were prospective clinical trials and six studies were retrospective real-world studies. The articles included data regarding five different CBE stents, namely, the iCast/Advanta V12, Viabahn VBX, BeGraft, LifeStream, and JOSTENT. Lesion severity was higher in real-world studies, with more TransAtlantic Inter-Society Consensus Classification class D lesions and a higher percentage of occlusions. All studies showed high rates of technical success and patency over the course of 12 months. Long-term data were only available for the iCast/Advanta V12 device, which had a primary patency rate of 74.7% at 5 years. Conclusions: CBE stents are a viable treatment option for patients with complex aortoiliac lesions because of their high rates of technical success and favorable patency across all devices at 12 months. However, long-term data are only available for a single device, the iCast/Advanta V12. The results of using this device were favorable over the course of 5 years.

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Section: Discussionmentioning

confidence: 99%

A systematic review of covered balloon-expandable stents for treating aortoiliac occlusive disease

Mwipatayi

Ouriel²,

Anwari

et al. 2020

Journal of Vascular Surgery

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“…This study demonstrates successful management of the atherosclerotic occlusive disease of the infrarenal aorta and the iliac arteries using the AFX stent graft system in the largest single-centre experience published to date. Two other groups have previously discussed their experience with this technique, one a multicentre study by Maldonado et al 9 of 91 patients and one a single-centre series of 10 patients. 10 Similar to this series, patients had advanced AIOD with predominantly TASC D lesions (see Figs 1-3).…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of the aorto‐iliac segment in occlusive disease using the AFX unibody graft

Arnold

Delaney

Wong

et al. 2020

ANZ Journal of Surgery

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Background: The endovascular era has evolved the treatment of aorto-iliac occlusive disease (AIOD). Many institutions now use minimally invasive techniques including kissing iliac stents and covered endovascular reconstruction of the aortic bifurcation. These negate the high morbidity of open surgical reconstruction but do not allow for a crossover approach to treat infra-inguinal disease. The AFX stent does both by anatomically reconstructing the bifurcation in AIOD despite being marketed for aneurysmal aortic disease. This large, single-centre case series assesses the outcomes of treatment of AIOD using the AFX stent. Methods: Patients with AIOD who presented to our institution between September 2016 and August 2018 were considered for AFX stenting if kissing iliac stents extending into the aorta or aortobifemoral bypass was required. Patient, treatment and outcome data were recorded with a primary outcome of primary patency at 12 months. Results: AFX stenting was performed in 29 patients, with an average age of 69 years, 52% (15/29) patients had critical limb ischaemia. Technical success occurred in 100% of patients with clinical success in 96% (28/29). There were no cases of 30 day and 3 (10%) cases of 12 month mortality, 2 (7%) major and 7 (24%) minor complications arose. Median length of stay was 3 days. Primary patency at 12 months was 100% (n = 24). Conclusion: AFX stenting is a safe with satisfactory early results for the treatment of AIOD. The minimally invasive technique and preservation of cross-over approach makes AFX stenting a considered option for the treatment of AIOD.

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“…One significant advantage of the AFX2 is that it does not require an adjunctive proximal component to save the renal arteries, unlike conventional grafts; this allows the number of stents deployed to be reduced. Furthermore, limb extension can customized to the patient’s anatomy to accommodate a range of iliac diameters [16]. Thus, the AFX2 endograft is especially beneficial in patients with isolated iliac aneurysms [15].…”

Section: Discussionmentioning

confidence: 99%

Initial Experience and Potential Advantages of AFX2 Bifurcated Endograft System: Comparative Case Series

Ahn

Min

et al. 2019

VSI

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PurposeThe AFX2 endograft is a unibody, bifurcated stent graft that can be used to lower complications in certain patients. In this study, we retrospectively reviewed consecutive cases in which the AFX2 system was used to overcome the challenges of narrow distal aorta, as well as to reduce procedure time and contrast medium dose. Furthermore, we compared the results with matched patients treated using the Endurant II endograft system.Materials and MethodsThis was a retrospective observational study of nine patients with abdominal aortic aneurysm (AAA) who underwent endovascular aneurysm repair (EVAR) using the AFX2 device between June 2017 and April 2018 at Seoul National University Hospital. The patients had narrow distal aorta (n=3), reversed tapered neck (n=1), iliac artery aneurysm (n=2), chronic kidney disease patients (n=2), and impending rupture (n=1). Seven matched patients were treated using the Endurant II graft.ResultsIn the AFX2 group, the mean procedure time was 87.2 minutes, mean blood loss volume was 157.7 mL, and mean volume of contrast medium used was 48.3 mL. In the Endurant II group, the mean procedure time was 140.0 minutes, mean blood loss volume was 175.0 mL, and mean volume of contrast medium used was 119.3 mL.ConclusionOur preliminary experiences with selected AAA patients treated using the AFX2 endovascular repair system showed good outcomes compared with similar patients treated using the Endurant II system. Therefore, the AFX2 may be a good option to perform EVAR in patients of advanced age who have chronic kidney failure or narrow distal aorta.

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Treatment of Aortoiliac Occlusive Disease with the Endologix AFX Unibody Endograft

Abstract: This is the largest study to examine the use of the Endologix AFX unibody stent-graft for the treatment of AIOD. Use of the AFX stent-graft appears to be a safe and effective endovascular treatment for complex AIOD.

Cited by 58 publications

References 29 publications

A systematic review of covered balloon-expandable stents for treating aortoiliac occlusive disease

A systematic review of covered balloon-expandable stents for treating aortoiliac occlusive disease

Reconstruction of the aorto‐iliac segment in occlusive disease using the AFX unibody graft

Initial Experience and Potential Advantages of AFX2 Bifurcated Endograft System: Comparative Case Series

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