10-year Experience With Endologix Afx Endograft For The Treatment Of Aortoiliac Occlusive Disease
MARTYN KNOWLES, MD, MBA, O Jesse Mendes, Tyler Fleming, Micah Pherson, Ryan Meehan, Liliana Nanez, Jason Kim, Dorian deFreitas, Fernando Motta, Bobby Mendes.
UNC Rex Hospital, Raleigh, NC, USA.
OBJECTIVES: Endologix AFX unibody stent graft (AFX) has been shown to be effective for the management of complex aortoiliac occlusive disease (AIOD), as a more minimally-invasive option compared to open repair. Additionally, AFX repair is advantageous compared to kissing iliac stents, maintaining normal aortoiliac morphology. The study examines the mid-term and long-term results of the Endologix AFX unibody stent graft for treatment of AIOD.
METHODS: A single center retrospective review was performed of patients treated exclusively for AIOD with the AFX device between 2012 and 2021. One hundred and fifteen patients (68 females[58.6%]) were included for evaluation. Primary, assisted primary, and secondary patency rates were evaluated. Clinical improvement after the procedure was assessed using Rutherford classification and ankle/brachial index.
RESULTS: One hundred and eleven patients underwent AFX repair (68% with lifestyle-limiting intermittent claudication and 32% with critical limb ischemia). Technical success was 97%, 3 unsuccessful device passage and 1 rupture with subsequent open repair. Mean duration of follow-up was 28.2 ± 26.2 months. Complications included groin thrombosis (n=2 [1.8%]), groin infection (n = 4[3.6%]), common iliac rupture (n = 2[1.8%]), iliac dissection (n =1[0.9%]), and thromboembolic event (n = 3[2.7%]). Thirty-day mortality was 1.8% (2/112). Over the first year, Rutherford stage improved from a mean of 3.48 ± 0.70 to 0.88 ± 1.39 (p<.0001). However, 42 patients (37.5%) required 63 secondary procedures (48 infra-inguinal [76.2%] and 15 aortoiliac [23.8%]) over the study period. During the follow up period, AFX treatment of AOID was associated with primary patency rates of 86 ± 4% at 72 months, primary-assisted patency rates of 95 ± 3% at 108 months, and secondary patency rates of 99 ± 1% at 108 months. The survival rate was 61 ± 8% at 88 months of follow-up (Figure 1).
CONCLUSIONS: This study represents the most comprehensive series regarding the use of the Endologix AFX unibody stent-graft for the treatment of complex AIOD, and is shown to be safe, effective, and durable. In addition, given the high rate of concomitant infra-inguinal PAD, the use of the AFX device allows for maintenance of a normal aortic bifurcation, facilitating further endovascular treatment. 
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