Selection of Stents by Calculation of Arterial Cross-sectional Area in Modified Sandwich Technique for Complex Aortoiliac Arterial Lesions

Abstract

We prospectively evaluated the modified sandwich technique for treatment of complex aortoiliac arterial lesions using commercial stent grafts selected according to the arterial cross-sectional area. The primary outcomes were technical feasibility and mid-term follow-up results. We prospectively enrolled 13 patients (mean age 63.85±6.12years) with aortoiliac arterial lesions (5 infrarenal abdominal aortic dissections, 1 lower abdominal aortic occlusion, 5 iliac artery aneurysms, 1 external iliac arterial pseudoaneurysm, and 1 type IB endoleak following endovascular aneurysm repair) for endovascular repair with the modified sandwich technique. All lesions were complex and unsuitable for routine endovascular treatment. The bifurcated stent-graft diameters were determined by calculating the arterial cross-sectional area. Success and complication rates were recorded. Patients were followed for 20.69±6.51 (range 6-31) months and stent patency determined by contrast-enhanced ultrasound and computed tomography 1, 3, and 6months post-operatively and every 12months thereafter. The initial technical success rate was 100%, and no surgical complications occurred. The primary patency of the stent grafts was 100% during follow-up. Post-procedural type I "gutter" endoleaks occurred in 4 patients (30.8%) after 1month. At 3months, the endoleaks in 3 of the 4 patients had disappeared without treatment, and the remaining endoleak resolved after coil embolization. The sandwich technique is a safe and effective therapy for complex aortoiliac arterial lesions. Stent-graft sizes based on the arterial cross-sectional area can ensure technical success and reduce the rate of "gutter" endoleaks.