Results of endovascular revascularization of combined lesions of aortic bifurcation and iliac arteries in immediate and remote periods of follow up

• Mochalova A.B.
• Saaya Sh.B.
• Gostev A.A.
• Cheban A.V.
• Rabtsun A.A.
• Bugurov S.V.
• Bochkov I.V.
• Osipova O.S.
• Ignatenko P.V.
• Karpenko A.A.

Abstract

Background. The use of endovascular methods of treatment for steno-occlusive lesions of the aortic bifurcation and common iliac arteries is the subject of discussions. The “gold standard” of surgical treatment in Leriche syndrome is aortofemoral bypass grafting, however, it is associated with a risk for developing surgical complications up to 25%.

Objective. The purpose of this study was to evaluate the immediate and remote results of patency of the aortic bifurcation and iliac arteries after endovascular reconstruction.

Patients and methods. We retrospectively analyzed outcomes of treatment of patients operated on between January 2012 and December 2018 using the kissing-stenting of the aortic bifurcation for TASC-II C and D atherosclerotic lesions, assessing the parameters in the early postoperative period (clinical success, procedure-related complications, revascularization, in-hospital MACE and MALE) and in the remote period (primary patency, secondary patency, survival, limb salvage).

Results. Lower primary patency of the reconstruction zone was statistically significantly associated with such factors as “exit” of proximal portions of the stents above the aortic bifurcation, their diameter being less than 7 mm, and the presence of thrombotic masses in the infrarenal portion of the aorta (according to the findings of computed tomography). In elderly patients, the risk for amputation after surgery turned out to be significantly higher.

Conclusion. The use of kissing-stenting of the aorta and iliac arteries yielded satisfactory results both from the technical point of view in the early period and in preservation of late patency. However, the revealed predictors of primary patency loss suggest the necessity of more thorough planning of the procedure.

Keywords:endovascular treatment; Leriche syndrome; kissing-stenting; aortic bifurcation; iliac arteries

References

1. Kharazov A.F., Kalyev A.O., Isaev A.A. PAD prevalence in Russian Federation. Pirogov Russian Journal of Surgery. 2016; 7: 58‑61. DOI: https://doi.org/10.17116/hirurgia2016758-61. (in Russian)

2. Jaff M.R., White C.J., Hiatt W.R., et al. An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: a supplement to the inter-society consensus for the management of peripheral arterial disease (TASC II). Vascular Medicine. 2015; 20 (5): 465–478. DOI: https://doi.org/10.1177/1358863X15597877

3. De Donato G., Bosiers M., Setacci F., et al. 24-Month data from the BRAVISSIMO: a Large-Scale Prospective Registry on iliac stenting for TASC A & B and TASC C & D lesions. Annals of Vascular Surgery. 2015; 29 (4): 738–750. DOI: https://doi.org/10.1016/j.avsg.2014.12.027

4. Norgren L., Hiatt W.R., Dormandy J.A., et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). European Journal of Vascular and Endovascular Surgery. 2007; 45 (Suppl S): S5–67. DOI: https://doi.org/10.1016/j.jvs.2006.12.037

5. National guidelines for the diagnosis and treatment of diseases of the arteries of the lower extremities. Moscow: National Scientific and Practical Center of Cardiovascular Surgery named after A.N. Bakulev. 2019; 89. (in Russian)

6. Kasemi H., Marino M., Dionisi C.P., et al. Seven-year approach evolution of the aortoiliac occlusive disease endovascular treatment. Annals of Vascular Surgery. 2016; 30: 277–285. DOI: https://doi.org/10.1016/j.avsg.2015.07.016

7. Aihara H., Soga Y., Iida O., et al. Long-term outcomes of endovascular therapy for aortoiliac bifurcation lesions in the Real-AI Registry. Journal of Endovascular Therapy. 2014; 21 (1): 25–33. DOI: https://doi.org/10.1583/13-4410MR.1

8. Taeymans K., Jebbink G.E., Holewijn S., et al. Three-year outcome of the covered endovascular reconstruction of the aortic bifurcation technique for aortoiliac occlusive disease. Journal of Vascular Surgery. 2018; 67 (5): 1438–1447. DOI: https://doi.org/10.1016/j.jvs.2017.09.015

9. Psacharopulo D., Ferrero E., Ferri M., et al. Increasing efficacy of endovascular recanalization with covered stent graft for TransAtlantic Inter-Society Consensus II D aortoiliac complex occlusion. Journal of Vascular Surgery. 2015; 62 (5): 1219–1226. DOI: https://doi.org/10.1016/j.jvs.2015.06.218

10. Jongkind V., Akkersdijk G.J.M., Yeung K.K., et al. A systematic review of endovascular treatment of extensive aortoiliac occlusive disease. Journal of Vascular Surgery. 2010; 52 (5): 1376–1383. DOI: https://doi.org/10.1016/j.jvs.2010.04.080

11. Jebbink G.E., Holewijn S., Slump C.H., et al. Systematic review of results of kissing stents in the treatment of aortoiliac occlusive disease. Annals of Vascular Surgery. 2017; 42: 328–336. DOI: https://doi.org/10.1016/j.avsg.2017.01.009

12. Sharafuddin M.J., Hoballah J.J., Kresowik T.F., et al. Long-term outcome following stent reconstruction of the aortic bifurcation and the role of geometric determinants. Annals of Vascular Surgery. 2008; 22 (3): 346–357. DOI: https://doi.org/10.1016/j.avsg.2007.12.013

13. Matas M., Gonzalez D.J.M., Montull E. Antiplatelet therapy in endovascular surgery: the RENDOVASC study. Annals of Vascular Surgery. 2013; 27 (2): 168–177. DOI: https://doi.org/10.1016/j.avsg.2011.11.045

14. ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries endorsed by: the European Stroke Organization (ESO) the Task Force for the diagnosis and treatment of peripheral arterial diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular surgery (ESVS). European Heart Journal. 2017; 39 (9): 763–816. DOI: https://doi.org/10.1093/eurheartj/ehx095

15. Rutherford R.B., Baker J.D., Ernst C., et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. Journal of Vascular Surgery.1997; 26 (3): 517–538. DOI: https://doi.org/10.1016/s0741-5214(97)70045-4

16. Jebbink E.G., Holewijn S., Versluis M., et al. Meta-analysis of Individual Patient Data After Kissing Stent Treatment for Aortoiliac Occlusive Disease. Journal of Endovascular Therapy. 2019; 26 (1): 31–40. DOI: https://doi.org/10.1177/1526602818810535

17. Vasuri F., Fittipaldi S., Pini R., et al. Diffuse calcifications protect carotid plaques regardless of the amount of neoangiogenesis and related histological complications. BioMed Research International. 2015; 2015: 795672. DOI: https://doi.org/10.1155/2015/795672

18. Kim T.H., Ko Y.G., Kim U., et al. Outcomes of endovascular treatment of chronic total occlusion of the infrarenal aorta. Journal of Vascular Surgery. 2011; 53 (6): 1542–1549. DOI: https://doi.org/10.1016/j.jvs.2011.02.015

19. Jebbink G.E., Mors T.G., Slump C.H., et al. In vivo geometry of the kissing stent and covered endovascular reconstruction of the aortic bifurcation configurations in aortoiliac occlusive disease. Vascular. 2017; 25 (6): 635–641. DOI: https://doi.org/10.1177/1708538117708912

20. Vertes M., Juhasz I.Z., Nguyen T.D., et al. Stent protrusion >20 mm into the aorta: a new predictor for restenosis after kissing stent reconstruction of the aortoiliac bifurcation. Journal of Endovascular Therapy. 2018; 25 (5): 632–639. DOI: https://doi.org/10.1177/1526602818794959

21. Serra R., Bracale U.M., Jiritano F., et al. The Shaggy Aorta Syndrome: An Updated Review. Annals of Vascular Surgery. 2021; 70: 528–541. DOI: https://doi.org/10.1016/j.avsg.2020.08.009

22. Chernyavskiy М.A., Artyushin B.S., Chernov А.V., et al. A case report of endovascular treatment of patient with infrareneral aorta occlusion. Patologiya krovoobrashcheniya i kardiokhirurgiya. 2018; 22 (3): 81–85. DOI: https://doi.org/10.21688/1681-3472-2018-3-69-74 (in Russian)

23. Zatevakhin I.I., Shipovsky V.N., Magomedov Sh.G., Jurakulov Sh.R. Results of endovascular treatment of atherosclerotic lesions of the iliac arteries. Diagnostic and Interventional Radiology. 2010; 4 (2): 29–37. (in Russian)

24. Papoyan S.A., Shchegolev A.A., Mitichkin A.E., et al. Kissing-stenting in occlusion of the terminal abdominal aorta. Endovascular Surgery. 2016; 3 (3): 42–48. (in Russian)

25. Alekyan B.G., Tsygankov V.N., Frantsevich A.M., Kharazov A.F. Endovascular reconstruction in the occlusion of the infrarenal aorta in a patient with Lerish syndrome. Endovascular Surgery. 2016; 3 (4): 40–44. (in Russian)