use of stent grafts for treatment of aorto-iliac occlusive ... · use of stent grafts for treatment...
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Use of Stent Grafts for Treatment of Aorto-Iliac Occlusive Disease
Ehrin J. Armstrong MD MSc
University of Colorado
Denver, Colorado
USA
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Disclosure
Speaker name:
...........Ehrin Armstrong..........................................................
I have the following potential conflicts of interest to report:
Consulting: Abbott Vascular, Boston Scientific,
Cardiovascular Systems, Spectranetics
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
I do not have any potential conflict of interest
x
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Aortoiliac Occlusive Disease
• PAD involving only the iliac arteries can often be treated with
standard endovascular techniques.
Balloon expandable, balloon expandable covered, or self-expanding stents.
• Involvement of aorta may necessitate use of endografts.
Coverage of both aorta and iliac occlusive disease.
• Potential benefit of preserving native bifurcation.
Flow disturbance with kissing iliac stents
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B1 B2
B3 B4
C1 C2 C3
D1 D2 D3
D4 D5 D6
A
B
C
D
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Increased Coverage of Diffuse Disease
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Case Example – Isolated Aortic Disease
• 65 year old male
• Abrupt onset of bilateral lower extremity claudication and weakness (< 50 meters)
• Right ABI = 0.91
• Left ABI = 0.96
• ABIs decreased to 0.35 with exercise
• Elevated Doppler velocities up to 582 cm/sec in abdominal aorta
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CT Scan
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Procedural Plan
• Radial access – Pigtail catheter in abdominal aorta for angiography
• Left femoral access
– Ultrasound guided
– PreClose technique with 2 ProGlide catheters
– 20 Fr Sheath inserted
• 21 mm Gore c-TAG endoprosthesis to exclude aneurysm and thrombus
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Case Example – Extensive Disease
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• Multicenter, retrospective study of 91 patients with symptomatic AIOD.
– 74% of patients with lifestyle-limiting claudication.
• Mean follow up of 22 months.Maldonado et al, EJVES 2016
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Baseline CharacteristicsCharacteristic Result
Age (years) 68 ±10
Male Gender (n) 62%
ASA Class
II 16%
III 57%
IV 21%
Concomitant AAA ≥3.5cm 1 .7%
Ambulatory Status
Ambulatory 93%
Amb w/ assistance 5%
Wheelchair 2%
Maldonado et al, EJVES 2016
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Courtesy of Zachary Arthurs, MDMaldonado et al, EJVES 2016
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Courtesy of Zachary Arthurs, MDMaldonado et al, EJVES 2016
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Procedural Complications
N=91 %
Groin Infection 6 7%
Respiratory Failure 4 4%
Groin Hematoma 4 4%
Rupture 4 4%
Hemodynamic Instability 0 0%
Dissection 4 4%
Thromboembolic Event 3 3%
Iliac Injury 2 2%
Femoral Thrombosis 2 2%
Stroke 1 1%
Maldonado et al, EJVES 2016
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Freedom From Secondary Interventions
89%
1Yr88%
2Yr
Maldonado et al, EJVES 2016
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Retrospective review of 10 patients with TASC D AIOD.
All patients high risk for aortobifemoral bypass
All patients had rest pain, 4 had tissue loss
Mean follow-up 40 monthsVan Haren, et al JVS 2016
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Van Haren, et al JVS 2016
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Van Haren, et al JVS 2016
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Van Haren, et al JVS 2016
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Van Haren, et al JVS 2016
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Summary and Conclusions
Extensive aortoiliac occlusive disease involving the aorta and/or iliac arteries can be successfully treated with endografts.
High rates of procedural success, low morbidity.
Procedural planning crucial for sizing.
Tortuosity, minimal aortic diameter.
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Thank You
Ehrin J. Armstrong MD MSc
University of Colorado
Denver, Colorado
USA
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Use of Stent Grafts for Treatment of Aorto-Iliac Occlusive Disease
Ehrin J. Armstrong MD MSc
University of Colorado
Denver, Colorado
USA