Research Article

Severe aorto-iliac occlusive disease: Options beyond standard aortobifemoral bypass

Konstantinos Filis*, Constantinos Zarmakoupis, Fragiska Sigala and George Galyfos

Published: 12/27/2018 | Volume 2 - Issue 1 | Pages: 020-024

Mini Review

According to recent guidelines, endovascular angioplasty is the standard treatment for TASC A and B primary aorto-iliac occlusive (AIOD) disease, and the first-line approach for TASC C lesions [1,2].Extended TASC D occlusive disease is usually treated by open surgery yielding excellent patency rates at a cost of a higher mortality (2%-4%) and a severe morbidity (up to 10%) [3]. However, several studies have reported promising results after endovascular treatment of extensive AIOD and full reconstruction of the aortic bifurcation [4,5]. In a recent meta-analysis, Jongkind et al., concluded that endovascular treatment of extensive AIOD can be performed successfully by experienced interventionists in selected patients [6]. Although primary patency rates seem to be lower than those reported for surgical revascularization, reinterventions can often be performed percutaneously yielding a secondary patency comparable to surgical repair.

Common causes of chronic infrarenal aortic occlusion (CIAO) include: i) atherosclerotic occlusive disease; ii) middle aortic syndrome; iii) Takayasu arteritis; iv) fibromuscular dysplasia; v) neurofibromatosis; and vi) coral reef aorta [3,7-9]. Although standardized infrarenal aorto-bifemoral bypass (AoBFB) remains the surgical procedure of choice for CIAO, operative decisions may proceed beyond AoBFB in complicated cases. Different therapeutic strategies include axillo-(bi)femoral bypass (AxBFB), aortoiliac endarterectomy (AIE) or hybrid procedures. AxBFB grafting usually refers to patients of high risk for aortic clamping or patients with many comorbidities that prohibit an extensive transperitoneal procedure [10]. However, its primary patency is usually inferior compared to classic aortofemoral bypass surgery and AxBFB is associated with an increased risk for infections. In a recent systematic review, anatomical open procedures such as AIE showed very low perioperative mortality, with 5-year primary patency rates of over 80% [11]. Finally, hybrid procedures show equivalent midterm primary patency rates with the open procedures even for TASC D lesions while reducing perioperative mortality rates [12]. Hybrid procedures for aortoiliac disease usually include iliac stenting plus femoral endarterectomy or femorofemoral bypass.

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References

  1. Wressnegger A, Kinstner C, Funovics M. Treatment of the aorto-iliac segment in complex lower extremity arterial occlusive disease. J Cardiovasc Surg (Torino). 2015; 56: 73-79. Ref.: https://goo.gl/77uqTK
  2. Aggarwal V, Waldo SW, Armstrong EJ. Endovascular revascularization for aortoiliac atherosclerotic disease. Vasc Health Risk Manag. 2016; 12: 117-127. Ref.: https://goo.gl/Eb9Fvr
  3. Indes JE, Pfaff MJ, Farrokhyar F, Brown H, Hashim P, et al. Clinical outcomes of 5358 patients undergoing direct open bypass or endovascular treatment for aortoiliac occlusive disease: a systematic review and meta-analysis. J Endovasc Ther. 2013; 20: 443-455. Ref.: https://goo.gl/qYWV1N
  4. Krankenberg H, Schlüter M, Schwencke C, Walter D, Pascotto A, et al. Endovascular reconstruction of the aortic bifurcation in patients with Leriche syndrome. Clin Res Cardiol. 2009; 98: 657-664. Ref.: https://goo.gl/9TDU6u
  5. Mangialardi N, Ronchey S, Serrao E, Fazzini S, Alberti V, et al. Endovascular management of total juxtarenal aortic occlusive disease in high-risk patients: technical considerations and clinical outcome. J Cardiovasc Surg (Torino). 2017; 58: 422-430. Ref.: https://goo.gl/SRk6j3
  6. Jongkind V, Akkersdijk GJ, Yeung KK, Wisselink W. A systematic review of endovascular treatment of extensive aortoiliac occlusive disease. J Vasc Surg. 2010; 52: 1376-1383. Ref.: https://goo.gl/eJ37NF
  7. Verma H, Baliga K, George RK, Tripathi RK. Surgical and endovascular treatment of occlusive aortic syndromes. J Cardiovasc Surg (Torino). 2013; 54(1 Suppl 1): 55-69. Ref.: https://goo.gl/nmCpHc
  8. Kim SM, Jung IM, Han A, Min SI, Lee T, et al. Surgical treatment of middle aortic syndrome with Takayasu arteritis or midaortic dysplastic syndrome. Eur J Vasc Endovasc Surg. 2015; 50: 206-212. Ref.: https://goo.gl/uCKLHh
  9. Pranteda C, Menna D, Capoccia L, Sirignano P, Mansour W, et al. Simultaneous Open Surgical Treatment of Aortic Coral Reef and Leriche Syndrome: Case Report and Literature Review. Ann Vasc Surg. 2016; 32: 133. e1-5. Ref.: https://goo.gl/ea8892
  10. Illuminati G, Calio FG, Mangialardi N, Bertagni A, Vietri F, et al. Results of axillofemoral by-passes for aorto-iliac occlusive disease. Langenbecks Arch Chir. 1996; 381: 212-217. Ref.: https://goo.gl/fk2ECG
  11. Chiu KW, Davies RS, Nightingale PG, Bradbury AW, Adam DJ. Review of direct anatomical open surgical management of atherosclerotic aorto-iliac occlusive disease. Eur J Vasc Endovasc Surg. 2010; 39: 460-471. Ref.: https://goo.gl/QM4txW
  12. Chen TW, Huang CY, Chen PL, Lee CY, Shih CC, et al. Endovascular and Hybrid Revascularization for Complicated Aorto-Iliac Occlusive Disease: Short-Term Results in Single Institute Experience. Acta Cardiol Sin. 2018; 34: 313-320. Ref.: https://goo.gl/1dHHAa
  13. Styczynski G, Szmigielski C, Leszczynski J, Kuch-Wocial A, Szulc M. Abdominal aortic Doppler waveform in patients with aorto-iliac disease. Eur J Vasc Endovasc Surg. 2010; 39: 714-718. Ref.: https://goo.gl/vwp2ih
  14. Lowery AJ, Hynes N, Manning BJ, Mahendran M, Tawfik S, et al. A prospective feasibility study of duplex ultrasound arterial mapping, digital-subtraction angiography, and magnetic resonance angiography in management of critical lower limb ischemia by endovascular revascularization. Ann Vasc Surg. 2007; 21: 443-451. Ref.: https://goo.gl/Qo79FA
  15. Rosen RJ, Roven SJ, Taylor RF, Imparato AM, Riles TS. Evaluation of aorto-iliac occlusive disease by intravenous digital subtraction angiography. Radiology. 1983; 148: 7-8. Ref.: https://goo.gl/dZ1Wbg
  16. Mesurolle B, Qanadli SD, El Hajjam M, Goeau-Brissonnière OA, Mignon F, et al. Occlusive arterial disease of abdominal aorta and lower extremities: comparison of helical CT angiography with transcatheter angiography. Clin Imaging. 2004; 28: 252-260. Ref.: https://goo.gl/h9VXbn
  17. Krug B, Kugel H, Harnischmacher U, Heindel W, Fischbach R, et al. Diagnostic performance of digital subtraction angiography (DSA) and magnetic resonance angiography (MRA): preliminary results in vascular occlusive disease of the abdominal and lower-extremity arteries. Eur J Radiol. 1995; 19: 77-85. Ref.: https://goo.gl/HgWUSK
  18. Akinwande O, Ahmad A, Ahmad S, Coldwell D. Review of pelvic collateral pathways in aorto-iliac occlusive disease: demonstration by CT angiography. Acta Radiol. 2015; 56: 419-427. Ref.: https://goo.gl/2KqXCT
  19. Galyfos G, Filis K. Is the revised cardiac risk index the right risk index for vascular surgery patients? Crit Care Med. 2014; 42: e631-632. Ref.: https://goo.gl/LyUrp2
  20. Van Damme H, Piérard L, Gillain D, Benoit T, Rigo P, et al. Cardiac risk assessment before vascular surgery: a prospective study comparing clinical evaluation, dobutamine stress echocardiography, and dobutamine Tc-99m sestamibi tomoscintigraphy. Cardiovasc Surg. 1997; 5: 54-64. Ref.: https://goo.gl/gEi1bG
  21. Jun HJ. Experiences of Surgical Treatment for Juxtarenal Aortic Occlusion. Vasc Specialist Int. 2014; 30: 19-25. Ref.: https://goo.gl/QH9neu
  22. Yang SS, Kim YW, Park YJ, Kim DI, Woo SY, et al. Results of Open Surgical Repair of Chronic Juxtarenal Aortic Occlusion. Vasc Specialist Int. 2014; 30: 81-86. Ref.: https://goo.gl/tq9Wr5
  23. Galyfos G, Sigala F, Basigos G, Karantzikos G, Katsaragakis S, et al. Hybrid Treatment of an Abdominal Aortic Aneurysm with Severe Calcification of the Neck and Aortic Bifurcation. Ann Vasc Surg. 2016; 36: 294.e7-294.e11. Ref.: https://goo.gl/MPoczn
  24. Papadimitriou D, Mayer D, Lachat M, Pecoraro F, Frauenfelder T, et al. A clampless and sutureless aortic anastomosis technique using an endograft connector for aortoiliac occlusive disease in which the aorta cannot be clamped or sewn due to calcification or scarring. Vascular. 2012; 20: 262-267. Ref.: https://goo.gl/iCvUoD
  25. Suzuki K, Mizutani Y, Soga Y, Iida O, Kawasaki D, et al. Efficacy and Safety of Endovascular Therapy for Aortoiliac TASC D Lesions. Angiology. 2017; 68: 67-73. Ref.: https://goo.gl/kR8GXH
  26. Sixt S, Krankenberg H, Möhrle C, Kaspar M, Tübler T, et al. Endovascular treatment for extensive aortoiliac artery reconstruction: a single-center experience based on 1712 interventions. J Endovasc Ther. 2013; 20: 64-73. Ref.: https://goo.gl/cs7dwv
  27. Panaretou V, Toufektzian L, Siafaka I, Kouroukli I, Sigala F, et al. Postoperative pulmonary function after abdominal aortic aneurysm repair in patients with chronic obstructive pulmonary disease: epidural versus intravenous analgesia. Ann Vasc Surg. 2012; 26: 149-155. Ref.: https://goo.gl/NnqiBU
  28. Galyfos G, Sianou A, Filis K. Pleiotropic effects of statins in the perioperative setting. Ann Card Anaesth. 2017; 20(Supplement): S43-S48. Ref.: https://goo.gl/zzu1Gd
  29. Galyfos G, Filis K, Sigala F, Geropapas G. Beta-blockers in vascular surgery patients: is the debate still going on? J Anesth. 2016; 30:1031-1036. Ref.: https://goo.gl/yV6ovp
  30. Filis K, Tsioufis C, Sianou A, Triantafillou K, Sigala F, et al. Critical evaluation on proper antithrombotic treatment in different groups of patients undergoing vascular surgery. Hellenic J Cardiol. 2018 30. pii: S1109-9666(18)30071-X. Ref.: https://goo.gl/NuvapQ
  31. San Norberto, E, Carrera S, Tyalor J, Vaquero C. Thirty years with a chronic aortic occlusion. J Vasc Surg 2013; 57: 1128. Ref.: https://goo.gl/VpH25T