Endovascular Treatment Showing Promising Short-Term Results in Patients with Total Bilateral Aortoiliac Occlusion

Abstract

Background: Endovascular treatment (ET) is a treatment option for aortoiliac occlusive disease in patients with critical symptoms. ET is the choice for the transatlantic inter-society consensus for the management of peripheral arterial disease (TASC II) type A and B lesions. However, its use for type C and D lesions is getting more popular due to its less invasive nature and feasibility for more patients than open surgery. Objectives: To describe short term results of ET in the treatment of total bilateral aortoiliac occlusion and discuss its role in the treatment of such lesions. Patients and Methods: Patients with total bilateral aortoiliac occlusion with either life disturbing claudication or critical limb ischemia symptoms, including rest pain or limb ulcer, who were unresponsive to exercise and medical treatment were chosen and underwent ET and were followed up. Their demographic data and possible risk factors were recorded. Activity level before and after the procedure was compared using paired sample T test. Satisfaction mean and standard error was calculated and three months, six months, and twelve months patency rates were calculated and 95% confidence interval (CI) was made using binomial exact test. Results: Fifteen patients met the inclusion criteria and underwent ET. Technical success was achieved in all cases. There were two cases of early mortality due to concomitant coronary artery disease (CAD) and prior poor medical condition. Patients satisfaction mean was 7.9 out of 10 (SE: 0.5) and activity level after procedure was significantly higher than before (1.53 and 2.58; P < 0.001). Primary patency rates at 3, 6, and 12 months were respectively 92.3% (24 of 26 limbs, CI = [74.7, 99.0]), 90.9% (20 of 22 limbs, CI = [70.8, 98.9]), and 83.3% (15 of 18 limbs, CI = [58.6, 96.4]). For 12 months follow-up, secondary patency rate increased to 88.9% (16 0f 18 limbs, CI = [65.3, 96.4]). Conclusion: When comparing patency rates for ET and open surgery no significant difference is seen (CI [58.6, 96.4], 93.6) and since re-intervention after ET with no delay is possible, it sounds a good treatment choice for total bilateral aortoiliac occlusions. Endovascular treatment of total bilateral aortoiliac occlusions can be a valid option with promising results and fewer complications that especially can be considered in high-risk patients. Further studies are recommended.