Midterm Outcomes of Endovascular Treatment of TransAtlantic Inter-Society Consensus Class D Total Aortoiliac Occlusions

Management of TransAtlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) class D total aortoiliac occlusions is traditionally by open surgery. Advancements in stent design and tools for crossing and true lumen re-entry have made endovascular repair an option for carefully selected patients. The aim of this study was to evaluate our center's outcomes treating such lesions from an endovascular approach. This was a retrospective review of all percutaneous interventions for TASC II type D aortoiliac occlusions performed between April 2010 and February 2012 at a single practice. Preoperative demographic data, risk factors for atherosclerosis, clinical symptoms, and postoperative follow-up were evaluated. During this time period, 10 patients underwent endovascular repair for symptomatic TASC II type D aortoiliac occlusions. Technical success was achieved in all patients by percutaneous access via bilateral femoral arteries and additional brachial access in four of 10 patients. The use of re-entry devices was necessary in seven of 10 patients. Initial aortic ICast stenting (Atrium Maquete Getinge Group), followed by ICast stents into the bilateral iliac arteries, was performed in all cases. Extension with nitinol stents to the external iliacs was routine. Average length of surgery was 166 minutes, with 171 mL contrast used. There were minor postoperative complications in four of 10 patients. No patients died ≤30 days of the procedure. Median length of stay was 1 day. The average follow-up was 24.5 months. Three patients were lost to follow-up. Mean preoperative Rutherford class was 3.7 and at follow-up was 2.0. Two of 10 patients required reintervention due to worsening of symptoms. Therapy failed in one patient at 19 months, and his leg became unsalvageable despite revascularization. Primary patency at follow-up was five of seven (71%), and primary assisted patency was six of seven (86%). An endovascular approach to complex total aortoiliac occlusions is feasible and shows promising midterm results with effective resolution of symptoms, low mortality rates, and low lengths of stay is this small series. Technical success required frequent use of reentry devices and brachial access. Further prospective studies and longer-term follow-up are needed to confirm these initial results.