Newer Adjuncts To Facilitate Endovascular Treatment Of Complex Severe Aortoiliac Occlusive Disease Previously Requiring Open Surgical Treatment
Palma M. Shaw, MD, Michael Costanza, MD, Leanne Grafmuller, BS, Fernando Joglar, MD.
Upstate Medical University, Syracuse, NY, USA.
Objective: Endovascular management of aortoiliac occlusive disease has been replacing the traditional method of aortobifemoral or extra-anatomic bypass. We describe our experience with the newest methods for endovascular and hybrid reconstruction of complex aortoiliac occlusive disease.
Methods: We retrospectively reviewed prospectively collected data for our series of aortoiliac endovascular reconstructions. Pre-operative planning using CT Angiography with vascular specific device selection tailored to each patient’s anatomy was conducted. Details regarding intraoperative techniques for recanalization, hybrid adjuncts, outcomes, length of stay, and mid-term patency were analyzed. Postoperative care included smoking cessation; dual anti-platelet agents or low dose Novel oral anticoagulants (NOAC).
Results: Technical success was achieved in all 10 patients with complex endovascular aortic reconstruction. Mid-term patency was confirmed with either CT Angiography or Duplex ultrasound over 1-6 months. Standardization of the procedure using balloon expandable stent-grafts was developed including adjunctive maneuvers to facilitate success such as including use of intravascular ultrasound, body-floss technique, and hybrid maneuvers to optimize runoff.
Conclusions: Endovascular reconstruction of the aortoiliac bifurcation with balloon expanding and self-expanding vascular-specific stent grafts is safe and feasible with good results. With these advanced techniques and newer devices, an endovascular approach should be the preferred method replacing open bypass in most cases with few exceptions.
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