Endovascular treatment of isolated atherosclerotic stenosis of the infrarenal abdominal aorta: Long-term outcome

Abstract

Conclusion: Aortic angioplasty is an effective treatment for isolated atherosclerotic stenosis of the infrarenal abdominal aorta, with primary patency rates of 94% at 1 year, 89% at 3 years, and 77% at 5 years. Summary: A total of 86 patients (36 women, 50 men, mean age 53.2 + 12.7 years) from 18 European centers who underwent endovascular treatment of symptomatic atherosclerotic occlusive lesions of the infrarenal abdominal aorta were evaluated. Only cases of isolated stenosis confined to the infrarenal aorta >10 mm from the aortic bifurcation were included. Indication for treatment was claudication in 74 of the 86 cases. Mean preprocedure ankle-brachial index was 0.71 and mean diameter reduction of the aorta was 77%. There was circumferential aortic calcification in 35%. A single balloon technique was used in 60 cases and a double balloon technique in 26 cases. Stents were employed in 88% of cases. There was one mortality unrelated to treatment of the aortic lesion. There were four technical failures with residual stenosis >30%. Early morbidity occurred in 9.3% and included retroperitoneal hematoma in one patient, peripheral embolism in two patients, and puncture site hematoma in three patients. Survival at 3 years was 91%. Primary patency of the angioplasty sight was 94% at 1 year, 89% at 3 years, and 77% at 5 years. Three patients developed aortic thrombosis at the treatment site at 8, 41, and 49 months, respectively. Sixty-five patients (76%) were symptomless at last follow-up. The mean ankle-brachial index at follow-up was 0.89 (P < .01 compared with pretreatment values). Age, gender, length of stenosis, circumferential aortic calcification, and stent usage did not affect long-term patency. Comment: This article has all of the disadvantages of a retrospective study, including varying techniques of angioplasty, different stents, lack of consistent use of pressure gradients, and no consistent follow-up protocol. Nevertheless, very acceptable initial technical success and reasonable long-term primary patency appear possible with aortic dilatation.