Primary Endovascular Stent Placement for Focal Infrarenal Aortic Stenosis: Long-term Results

doi:10.1097/01.RVI.0000228374.85266.64

Journal of Vascular and Interventional Radiology

Volume 17, Issue 7, July 2006, Pages 1105-1109

https://doi.org/10.1097/01.RVI.0000228374.85266.64 Get rights and content

PURPOSE

The objectives of this retrospective study were to determine the technical success, safety, and long-term results of primary stent implantation in infrarenal aortic stenosis.

MATERIALS AND METHODS

A total of eight atherosclerotic stenoses and one occlusion of the infrarenal aorta (ie, midaortic syndrome) were treated with endoluminal stent placement after balloon angioplasty. Aortoiliac lesions were excluded. Technical success and patency were assessed.

RESULTS

Primary technical success in percutaneous transluminal angioplasty and subsequent stent placement was achieved in all patients. No complications occurred, and no morbidity was encountered. Primary clinical patency rates were 100% on all follow-up examinations. Long-term results with a mean follow-up of 110 months (range, 99–117 months) were recorded in seven patients; one patient had died and one was lost to follow-up.

CONCLUSIONS

In view of the excellent initial results and promising long-term follow-up data in a small series, stent placement after predilation in properly selected patients with isolated infrarenal aortic stenosis appears to be a promising, durable treatment. It should be considered as a primary method of treatment.

Section snippets

Study Population

During a 2-year period from 1994 through 1995, nine focal aortic stenoses of the infrarenal aorta (five men, four women) were treated with stent placement after dilation. The mean age was 62 years (range, 45–82 years). Institutional review board approval was not required for this study.

Inclusion and Exclusion Criteria

As described in our study on short and midterm results (9), eight patients were included who had focal suprabifurcational aortic stenosis, comprising five eccentric lesions with a smooth surface, one eccentric

Early and Midterm Results

The short-term and midterm results have been described in our previous work (9). Therefore, they are summarized here briefly to provide a better context for the long-term outcomes and general perspective.

Primary technical success in the form of stent placement was achieved in all patients. All patients attended the first follow-up appointment scheduled at 6 months after stent placement (range, 3–8 months). All patients participated in the second follow-up appointment scheduled at 12 months

DISCUSSION

Focal infrarenal aortic stenosis not extending to the bifurcation or iliac arteries is infrequent. Patients with infrarenal aortic stenosis are usually younger and have less extensive atherosclerotic disease than patients who present with iliofemoral or more peripheral disease (2). These patients have a longer life expectancy than the average patient with claudication. The long-term results of surgery are well documented in the literature, with graft patency rates of 90% at 5 years and 75% at

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Cited by (29)

Early and long-term results of the endovascular treatment of patients with isolated infrarenal aortic stenosis
2021, Journal of Vascular Surgery
Citation Excerpt :
There are, however, also disadvantages (eg, larger introducer sheath is necessary, and the price of a covered stent is much higher than the price of a bare-metal stent). There were no symptoms of mesenteric ischemia after any of our procedures, similar to other studies.5,9,10 Theoretically, stent implantation across the inferior mesenteric artery may cause mesenteric ischemia; however, clinical practice shows that it occurs only in such cases in which superior mesenteric or celiac artery occlusive disease, enlarged and tortuous inferior mesenteric artery, or bilateral hypogastric artery occlusion is diagnosed in the patient.17
The purpose of this study was to report our results of patients' characteristics, procedural complications, and long-term patency in treatment of isolated infrarenal aortic stenosis (IIAS).
Forty symptomatic patients (28 female, 12 male; median age, 60 years [54.8-68 years]) with IIAS who underwent endovascular intervention between 2001 and 2017 were retrospectively analyzed. Patient, lesion, procedure, and balloon/stent characteristics were assessed. Follow-up included clinical status evaluation and color Doppler ultrasound examination.
The cause of IIAS was atherosclerosis in all patients. Twenty percent of the patients were younger than 50 years; 85% had hypertension, 80% were smokers, 38% had hyperlipidemia, 23% had diabetes mellitus, 15% were obese (body mass index ≥30 kg/m²), and 8% had chronic kidney disease. The median stenosis grade was 80% (70%-80%), and the median lesion length was 19.9 mm (13-29.4 mm). Severe calcification was present in 8% of the patients. Percutaneous transluminal angioplasty was performed in four cases (10%), whereas stenting was performed in 36 (90%). One complication, an aortic rupture requiring surgical repair, occurred. The median follow-up was 61 months (17-101 months). The primary patency rate was 100% at 6 months, 97% at 12 and 24 months, and 88% at 60 and 96 months. Restenosis developed in three patients (8%); reintervention was carried out in two cases (5%).
Endovascular therapy for IIAS provides a safe and effective long-term treatment strategy.
Endovascular Aortic Repair for Isolated Infrarenal Aortic Stenosis
2019, Annals of Vascular Surgery
An 87-year-old man with severe intermittent claudication and lower limb pain at rest was referred to our hospital for examination. Computed tomography (CT) angiography imaging showed a severe stenosis in the infrarenal abdominal aorta. The ankle brachial indices (ABIs) were 0.62 (right) and 0.60 (left). Endovascular aortic repair was performed with distal protection. The postoperative course was uneventful, and postoperative CT showed no stenosis or distal embolization. The ABI improved to the normal values of 1.02 (right) and 1.13 (left). The patient was followed up as an outpatient without a cane. Long-term follow-up and randomized controlled trials are necessary to clarify the durability and efficacy of the endovascular approach for this aortic pathology.
Transbrachial and femoral artery approach endovascular therapy for flush infrarenal aortic occlusion
2014, European Journal of Vascular and Endovascular Surgery
The purpose of this study is to report the efficacy of transbrachial and femoral artery approach endovascular therapy with catheter-directed thrombolysis (CDT) and adjunctive therapy for flush infrarenal aortic occlusion (FIAO).
From March 2012 to December 2013, 11 consecutive patients (9 males; mean age 68 years; range 54–80 years) were submitted to endovascular therapy for FIAO. All patients were treated with CDT initially and then adjunctive endovascular treatments were performed to correct the underlying lesions.
Complete reconstruction of occluded aortoiliac arteries was successfully achieved in 81.8% (9/11) of patients. Left brachial and bilateral femoral arterial accesses were obtained in nine patients, and brachial and unilateral femoral in two patients. The residual lesions after CDT were corrected in nine patients and concomitant endovascular recanalization of superficial femoral artery was performed in two patients. Self-expandable stents were implanted in the all aortoiliac lesions with pre- and post-dilation. No renal or distal runoff embolization was seen during intraoperative angiography. Seven (7/9) patients with rest pain or tissue loss showed significant improvements in symptoms and two (2/9) patients with intermittent claudication gained an improved walking distance. The ABI rose significantly between pre- and post-procedure (0.84 ± 0.18 vs. 0.44 ± 0.13 on the right leg, p < .01; 0.89 ± 0.23 vs. 0.48 ± 0.16 on the left, p < .01).
Transbrachial and femoral artery approach endovascular therapy for FIAO offers an alternative to surgical reconstruction with immediate outcomes.
Endovascular therapy for long-segment atherosclerotic aortoiliac occlusion
2014, Journal of Vascular Surgery
Citation Excerpt :
However, surgical treatment is associated with significant perioperative morbidity and mortality in high-risk patients4-6 and is also generally associated with delayed recovery and prolonged hospitalization. Endovascular therapy has proven to be an excellent alternative to open surgery, especially for short stenoses of the aorta and the iliac arteries.10-14 Various authors have described the deployment of stents for short-segment aortoiliac occlusion.
This retrospective nonrandomized study investigated the outcomes of endovascular therapy for long-segment atherosclerotic aortoiliac occlusion.
From May 2008 to January 2013, 20 patients (one woman and 19 men; mean age, 66.1 years; range, 43-89 years) underwent stent implantation, with or without catheter-directed thrombolysis (CDT), for long-segment aortoiliac occlusion (>10 mm).
The technical success rate was 95% (19 of 20). No in-hospital mortality was recorded. Aortic thrombus was successfully eliminated with CDT in four patients before percutaneous transluminal angioplasty (PTA) and stenting. Retroperitoneal hemorrhage occurred in one patient, who refused further endovascular surgery. Another 15 patients were treated with PTA and stenting. Postoperative ankle-brachial indexes increased significantly from preoperative values (P < .05). Seventeen patients showed clinical improvement from baseline by an average of 2.5 Rutherford categories. The mean follow-up interval was 17.6 months (range, 4-39 months). The primary patency rates were 93.3% ± 6.4% at 6 months, 83% ± 11.3% at 18 months, and 66.4% ± 17.4% at 24 months.
Through brachial and femoral artery puncture, PTA, stenting, and CDT, endovascular therapy is feasible for complete long-segment infrarenal aortic occlusion, with lower complication rates and favorable midterm patency.
Outcomes of endovascular treatment of chronic total occlusion of the infrarenal aorta
2011, Journal of Vascular Surgery
Few reports have been published on the outcomes of endovascular therapy in chronic total occlusion of the aorta.
Endovascular treatment was attempted in 49 patients (40 men and nine women; aged 64.1 ± 10.9 years) with infrarenal aortic occlusion between January 1995 and December 2009. The first attempt at wire passage and balloon angioplasty was usually performed by an antegrade approach through the brachial artery. Stents were implanted with or without intra-arterial administration of thrombolytic agents. We investigated the immediate and midterm outcomes of endovascular therapy for chronic infrarenal aortic occlusions.
Technical success was achieved in 40 patients (81.6%). Procedural failures were due to wire passage failure in eight patients and to embolization and spinal cord infarction in one. Stents were implanted in 97.5% of patients. Major complications occurred in eight patients (16.3%): two neurologic events (spinal and cerebral infarction), two cases of jailed renal artery after stenting, and one case each of periprocedural death from pneumonia, distal embolization requiring embolectomy, iliac artery rupture requiring implantation of covered stents, and access site pseudoaneurysm treated with surgery. In patients treated successfully, the primary patency rate was 88.4% at 1 year and 80.1% at 3 years. The major amputation rate was 0%. Seven patients (17.5%) required repeat intervention (n = 5) or bypass surgery (n = 2) during the follow-up period.
Endovascular therapy of infrarenal aortic occlusion was feasible in most cases, and midterm patency was favorable. However, because of relatively high procedurally related complication rates, cautious selection of patients and appropriate preventive measures are necessary to improve immediate outcomes.
Endovascular treatment as first line approach for infrarenal aortic occlusive disease
2011, Journal of Vascular Surgery
The purpose of this study was to report the early and late results of primary stenting for focal atherosclerotic lesions of the infrarenal aorta.
A retrospective analysis of 52 consecutive patients treated for infrarenal occlusive aortic disease with primary stenting between January 2002 and November 2009 was performed. Original angiographic imaging, medical records, and noninvasive testing were reviewed. Primary stenting was the first line of treatment. Perioperative technical success and Kaplan-Meier estimates for patency and survival were calculated.
The majority of the patients (43) were treated for severe claudication (Rutherford III; 82.7%), 5 for ischemic rest pain (Rutherford IV; 9.6%), and 4 for minor tissue loss (Rutherford V; 7.7%). Aortic stenosis was found in 40 cases (76.9%) and occlusion in 12 (23%). Perioperative hemodynamic success was 100%. All patients had an improvement of ankle brachial index (ABI) >0.10. Clinical improvement was found in 96%. Early surgical revision was necessary for aortic rupture in 1 patient. One death occurred for pneumonia. The mean follow-up time was 39.4 ± 27.2 months. Ten reinterventions (19%) were needed for symptom recurrence. The estimated assisted primary patency at 9 years was 96% and the mean survival time was 86.6 months.
Primary stenting offers safe and durable results and should be considered as the first line of treatment for focal aortic lesions.

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: None of the authors have identified a conflict of interest.

View full text

Primary Endovascular Stent Placement for Focal Infrarenal Aortic Stenosis: Long-term Results

PURPOSE

MATERIALS AND METHODS

RESULTS

CONCLUSIONS

Section snippets

Study Population

Inclusion and Exclusion Criteria

Early and Midterm Results

DISCUSSION

J Vasc Interv Radiol

J Vasc Interv Radiol

J Vasc Interv Radiol

J Vasc Surg

J Vasc Interv Radiol

Lancet

J Vasc Intervent Radiol

Eur J Vasc Endovasc Surg

Ann Vasc Surg

Am Heart J

Infrarenal aortic stenosis: value of stent placement after percutaneous transluminal angioplasty failure

Radiology

Clinical and anatomical considerations for surgery in aortoiliac disease and results of surgical treatment

Circulation

Mechanical revascularization of occluded iliac arteries with use of self-expandable endoprostheses

Radiology

Endarterectomy versus angioplasty in the treatment of localized stenosis of the abdominal aorta

Can J Surg