Outcomes of Endovascular Reconstructive Techniques in TASC II C-D Aortoiliac Lesions

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Objective: To describe outcomes following endovascular reconstruction of TASC C/D lesions involving the infrarenal aorta and aortic bifurcation with advanced techniques. Methods: This is an observational, retrospective, single-center cohort experience. In a five years period, we selected patients underwent endovascular treatment for obstructive aorto-iliac TASC C/D disease with involvement of the infrarenal aorta and/or the aortic bifurcation. Early (< 30 days) outcomes were mortality, major amputation and thrombosis. Late mid-term (1, 3 years) outcomes were primary, assisted primary and secondary patency, limb salvage rate and freedom from reintervention. Results: A total of 87 patients were treated during the index period. Kissing covered stent (cKS), covered reconstruction of aortic bifurcation (CERAB) and unimodular bifurcated AFX Unibody stent-graft (Bif-SG) implantation were performed in 35 (40.4%), 26 (29.8%) and 26 (29.8%) cases, respectively. Bif-SG group included 11 (11/26, 42.3%) patients treated for abdominal aortic aneurysm associated with obstruction of the aortic bifurcation. Technical success was achieved in all cases and no ruptures or conversion to open surgery were recoded. Median follow-up age was 18 months (interquartile range [IQR], 8-34). Overall primary patency rate was 91.2% (95% confidence interval [CI]: 81.3-95.9) at 1 year and 83.5% (95% CI: 69.6-91.4) at 3 years. Assisted primary patency was 96.9% (95% CI: 87.8-99.2) at 1 and 3 years. Secondary patency was 97.8% (95% CI: 85.5-99.6) at 3 years. Limb salvage rate was 98.6% (95% CI: 90.1-99.7) at 1 and 3 years and, freedom from reintervention was 98.4% (95% CI: 88.9-99.7) at 1 year and 87% (95% CI: 66.1-95.4) at 3 years. No significant differences were observed between the types of aorto-iliac reconstruction and the levels of aortic involvement (infrarenal, inframesenteric, bifurcation). Univariate analysis did not identify any factor affecting primary patency rate. Conclusion: Endovascular reconstruction in severe aorto-iliac obstructions using advanced techniques offered promising mid-term patency rates and profiles of safety. The variety of reconstructive configurations allow surgeons to customize on patients’ anatomies the type of revascularization. Publication History Article published online: 10 June 2022 © 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

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