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Home > Vascular Annual Meeting > RR22. Neoaortoiliac System (NAIS) for Failed...

RR22. Neoaortoiliac System (NAIS) for Failed Aortic Reconstructions: A Durable Solution in Young Patients

Stephen T. Smith, Carlos H. Timaran, Daniel J. Hayes, Frank R. Arko, J. Gregory Modrall, R. James Valentine, G. Patrick Clagett
UT Southwestern, Dallas, TX

OBJECTIVES: Failure of prosthetic aortofemoral bypass (AFB) in young patients is a difficult problem that requires complex re-interventions with high rates of failure leading to major amputation. We hypothesize that neoaortoiliac system (NAIS) reconstruction improves patency and limb salvage in these patients.

METHODS: 16 patients with a median age of 53 (interquartile range (IQR), 48-60) years were identified from our prospectively gathered registry with failed AFB treated by NAIS reconstruction from April 1997 to April 2008. The patency rate and outcome of the original AFB was compared to the patency rate and outcome following subsequent NAIS reconstruction in a paired analysis. Survival analysis with log-rank comparisons test was used to construct Kaplan-Meier life tables. Patients with evidence of graft infection were excluded.

RESULTS: The median number of interventions after AFB was 1.26 (IQR 0.3-2.3) including thrombectomy (n=4), thrombolysis (n=2), angioplasty/stenting (n=3), limb revision (n=4), femoral crossover graft (n=3), and repeat AFB (n=4). All patients exhausted their endovascular options before reoperative surgery was considered. Prior to NAIS, all patients had critical limb ischemia with median ankle brachial indices of 0.40 (IQR 0.23-0.86) on the right and 0.49 (IQR 0.0-0.64) on the left. After NAIS, all patients had marked improvement in symptoms and postoperative ankle brachial indices rose to 0.92 (IQR 0.89-0.98) on the right and 0.80 (IQR 0.75-0.99) on the left (p =0.001). Primary patency rates of the original AFB versus NAIS reconstruction were 77% vs. 82%, 36% vs. 72%, and 29% vs. 72% at 1, 3, and 5 years (p=0.07) and secondary patency rates were 86% vs. 100%, 36% vs. 100%, and 29% vs. 100% at 1, 3, and 5 years (p=0.02). Limb salvage for NAIS reconstruction after failed AFB was 100%, 91% and 91% at 1, 3, and 5 years.

CONCLUSIONS: NAIS reconstruction appears to be a durable solution in young patients with critical limb ischemia from failed AFB and multiple endovascular interventions.

AUTHOR DISCLOSURES: S.T. Smith, None; C.H. Timaran, None; D.J. Hayes, None; F.R. Arko, None; J.G. Modrall, None; R.J. Valentine, None; G.P. Clagett, None.