External Iliac Occlusion Does Not Preclude Endovascular Management of Aortoiliac Disease–Technique and Evolution of Therapy

Abstract

Controversy remains over how to best manage chronic total occlusions of the aortoiliac (AI) system. Uncovered stents are the traditional choice but offer less durability in theory with the risk of stent ingrowth. External iliac artery (EIA) occlusions are challenging due to access difficulty. We performed a retrospective study of patients who had undergone endovascular AI intervention between December, 2014 and March, 2017 for Trans-Atlantic Inter-Society Consensus D lesions. The primary study end point was overall survival. Secondary end points included primary assisted or secondary patency and procedural complications. Twenty-one patients were identified in the 22-month period that underwent recanalization of at least 1 iliac segment, using Atrium iCAST in the aorta and common iliac segments and/or Viabahn stents in the external iliac arteries. Overall AI patency was 100% (mean 6.8months). Six AI bifurcation advancements were performed (primary patency 100%, mean 8months). Eight patients with EIA occlusion underwent total percutaneous revascularization (primary patency 88%, secondary patency 100% mean 6months). Five outflow procedures were performed concurrent to the AI recanalization. Two patients (15.4%) died of cardiovascular events. No access site complications were observed in the cohort. AI occlusive disease remains a surgical challenge. Although uncovered stents are a common therapy for revascularization of this vascular bed, our experience with balloon-expanding and self-expanding covered stents suggests they may be used to good effect with minimal complications in the intermediate term.