ORIGINAL ARTICLE   

Italian Journal of Vascular and Endovascular Surgery 2018 December;25(4):288-93

DOI: 10.23736/S1824-4777.18.01370-0

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Endovascular treatment of juxtarenal aortic occlusion

Sonia RONCHEY ¹ ✉, Barbara PRAQUIN ¹, Matteo ORRICO ², Angelo SANFIORENZO ¹, Adalberto SANZONE ¹, Nicola MANGIALARDI ²

¹ Unit of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy; ² Unit of Vascular Surgery, San Camillo Forlanini Hospital, Rome, Italy

BACKGROUND: Aorto-bifemoral bypass is still considered the gold standard for complex aorto-iliac disease but is associated to relevant morbidity and mortality. Endovascular treatment is emerging as an alternative, but the best stent configuration is not yet established. The aim of this study was to evaluate the feasibility and long-term results of endovascular treatment for juxtarenal aortic occlusions with self-expandable stents.
METHODS: Between December 2008 and December 2017, 23 patients with juxtarenal aorto-iliac occlusion were treated by endovascular means at our department. About 26.1% of the patients had an associated occlusion of one renal artery, and 8.7% a stenosis. Antegrade recanalization from percutaneous brachial access and retrograde angioplasty and stenting were performed. Renal arteries (RAs) protection devices were routinely used after the first four patients. Aorto-iliac self-expandable stents were deployed in all cases.
RESULTS: Technical success was 100%, no patient died. Major complications occurred in 13% of the patients (three embolizations, one iliac rupture). In 10 cases (43.5%), adjunct were needed to maintain renal artery patency (six chimney, two renal stentings through the stents struts, two aorto-iliac stents placed above the renal arteries). Mean follow-up was 35 months (range 2-78 months): five patients died (21.7%), two reinterventions were performed (8.7%). Primary and secondary patency were 95.7% and 100%. All the renal arteries remained patent during follow-up.
CONCLUSIONS: Endovascular recanalization of juxtarenal aorto-iliac occlusion is feasible with good early, and long-term results if some precautions are used and should be considered even for low-risk patients.

KEY WORDS: Leriche Syndrome - Arterial occlusive diseases - Endovascular procedures - Iliac artery - Renal artery