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An Anatomic Description Of Aortoiliac Morphology And Implications For Treatment
Denston Emanuel Carey, Jr., MD, Ethan Chervonski, Thomas Maldonado, MD.
NYU Langone, New York, NY, USA.
Objective: Endovascular management of aortoiliac occlusive disease (AIOD) has evolved significantly over the past decade, providing durable treatment options for patients even in the face of increasingly complex disease. As the field continues to advance, it is of paramount importance to understand the anatomy of disease distribution and variety of stenting techniques. Here, we describe our 7-year experience with endovascular stenting of aortoiliac lesions and provide a detailed anatomic analysis of our patient population.
Methods: Our institution’s Vascular Quality Initiative (VQI) database was queried for patients undergoing endovascular stenting of at least one of the aortoiliac vessels for the treatment of intermittent claudication or critical limb ischemia. Pre/post-operative patient clinical and imaging data were obtained from the VQI and our EMR. TeraRecon was utilized for center-line reconstruction and vascular measurements. All statistical analyses were performed with STATA18.5.
Results: Fifty-five patients were included in the study, 19 were treated with kissing stenting or AFX (KS-AFX) and 36 with unilateral stenting (US). Three patients were treated with AFX and 5 of the kissing stent patients were treated based on contralateral common iliac artery protection. The mean age was 68.4 +/- 8.5 years, 69.1% were male and 27.3% were treated for CLI while 72.7% were claudicants and mean follow-up was 663 days. When compared (KS-AFX vs US), KS-AFX distal aortic diameter was smaller (14.3 +/- 3.0 mm vs 16.3 +/- 4.0 mm, P = 0.03, Table 1) and aortic stenosis was more likely to be present (36.8% vs 8.3%, P = 0.02). There was no difference in target lesion revascularization, symptomatic recurrence or change in ABI among the groups regardless of native patient anatomy or stent technique utilized.
Conclusions: AIOD patients have diverse anatomic features necessitating a broad repertoire of endovascular approaches that when selected judiciously result in durable patient outcomes. We saw high rates of clinical success with reconstruction of the bifurcation in patients with distal aortic disease using kissing stents and/or AFX. Unilateral stenting may be more suitable when the distal aorta is relatively spared of occlusive disease.
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