AAA 34. Endovascular Approach Replacing Surgical Repair for Aortoiliac Occlusive Disease

With the improvement and availability of endovascular interventions, there are numerous reports of endovascular treatment of iliac arteries to the aortic bifurcation, including cases of total occlusion. In light of treating aneurysms with aortic devices, endovascular repair of aortoiliac occlusive disease (AIOD) should be considered. In the last 2 years, we have performed numerous endovascular repairs of AIOD as an alternative to aortofemoral bypass. During this time, we performed 10 aortofemoral bypasses and 39 endovascular repairs for AIOD, of which 17 included aortic and iliac repair. We report a retrospective study of these endovascular repairs between 2017 and 2019 that include endovascular cases with aortic repair (17). All cases were performed through bilateral percutaneous femoral artery and left brachial artery access. This approach maintains revascularization through the true lumen by aorta to the external iliac. In some cases, a snare device was used to capture the wire. We report 100% technical success using numerous devices (Medtronic, Gore, and others), with only a single case of acute occlusion, most probably due to kink, that was repaired by thrombectomy and an additional stent. Most of our patients were male (88%), with an average age of 64 years; 85% of the patients had TransAtlantic Inter-Society Consensus (TASC) D lesions, with an average ankle-brachial index of 0.65 and toe-brachial index of 0.4. Postprocedure ankle-brachial index was 0.89 and toe-brachial index was 0.6. Because of the short follow-up interval, this study does not include long-term results (maximum, 24 months). As of now, we report one occlusion and overall good clinical results. We recommend endovascular repair as the primary choice for aortoiliac disease including total occlusion, especially in high-risk patients. The technical success and initial clinical results are proponents of this relatively novel approach. This procedure does not prevent future surgical repair if necessary. We hope to perform a multicenter study comparing endovascular and surgical repair with long-term follow-up.