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Endovascular management of chronic infrarenal aortic occlusion Moise MA; Alvarez-Tostado JA; Clair DG; Greenberg RK; Lyden SP; Srivastava SD; Eagleton M; Sarac TS; Kashyap VSJ Endovasc Ther 2009[Feb]; 16 (1): 84-92PURPOSE: To review our experience with the endovascular treatment of chronic infrarenal aortic occlusion with regard to technical success and midterm patency, as well as perioperative mortality and morbidity. METHODS: A retrospective review was performed of patients who presented from January 1, 2000, to December 31, 2005, with a diagnosis of chronic infrarenal aortic occlusion (TASC D) treated with endovascular techniques. In this time period, 31 patients (22 women; mean age 63 years) underwent attempted recanalization of the occluded aorta and iliac arteries. Claudication was the most common presenting symptom (14, 45%). Patients were treated solely with angioplasty and stenting or thrombolysis followed by angioplasty/stenting based on surgeon preference. RESULTS: Technical success was 93%. The 2 failures were individual cases of wire-induced iliac artery perforation and failed access; both patients were treated with bypass grafting. Nine (29%) patients had thrombolysis prior to angioplasty. There were no perioperative deaths. Postoperative ankle-brachial indexes increased significantly from preoperative values (p<0.0001). There were 3 technical complications: 1 (3%) iatrogenic iliac artery injury and 2 (6%) perioperative limb thromboses requiring intervention. Other complications included 6 (19%) access site events and 5 (16%) episodes of acute renal dysfunction, 2 requiring permanent dialysis. Over a mean follow-up of 12 months, there was no limb loss. At 1 and 3 years, the primary/secondary patency rates were 85%/100% and 66%/90%, respectively. CONCLUSION: Endovascular therapy for chronic infrarenal aortic occlusion has a high technical success rate, with good midterm primary and secondary patency rates. However, renal dysfunction can occur; the etiology is likely multifactorial from contrast volumes, embolization, and/or renal arterial disease.|*Angioplasty, Balloon/adverse effects/instrumentation[MESH]|*Iliac Artery/diagnostic imaging[MESH]|*Thrombolytic Therapy[MESH]|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Aortic Diseases/diagnostic imaging/mortality/*therapy[MESH]|Aortography[MESH]|Arterial Occlusive Diseases/diagnostic imaging/mortality/*therapy[MESH]|Chronic Disease[MESH]|Female[MESH]|Humans[MESH]|Kaplan-Meier Estimate[MESH]|Male[MESH]|Middle Aged[MESH]|Retrospective Studies[MESH]|Stents[MESH]|Time Factors[MESH]|Treatment Outcome[MESH]|Vascular Patency[MESH] |
