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PVSS21. Endovascular Management Of Chronic Infrarenal Aortic Occlusion

Mireille A. Moise., Javier A. Alvarez-Tostado, Daniel Clair, Roy K. Greenberg, Sean Lyden, Sunita Srivastava, Vikram S. Kashyap, Timur Sarac, Matthew Eagleton, Patrick J. O'Hara.
Cleveland Clinic, Cleveland, Ohio.  

OBJECTIVES: We reviewed our experience with the endovascular treatment of chronic infrarenal aortic occlusion between January 2000 and December 2005.

METHODS: We identified 22 patients from our prospectively recorded registry undergoing attempted recanalization of the occluded aorta and iliac arteries. Patient records were retrospectively reviewed for demographics, symptomatology, procedural details and peri-operative mortality and morbidity. Follow-up information regarding vessel patency was recorded.

RESULTS: Of 22 patients identified, 15 were female (67%). 20 (91%) patients smoked at some point and 14 (64%) were smoking at the time of revascularization. None were diabetic and pre-existing renal insufficiency was noted in 23%. Patients presented with claudication (50%), rest pain (14%), or tissue loss (14%), while one each presented for evaluation of renal artery stenosis, or mesenteric stenosis. Two patients were noted to have distal embolization in the toes and two presented with infected prosthetic grafts. One patient had an occluded axillo-bifemoral graft. Eight patients (36%) had thrombolysis of aortic thrombus performed as part of the recanalization procedure. Technical success was achieved in all but one patient (95%). There were no perioperative deaths with morbidity in five patients including four episodes of acute renal dysfunction, and no need for dialysis and one early thrombosis of the right iliac artery. Post-operative ABI's increased significantly from preoperative ABI's. With a mean follow-up of 11 months, there was no limb loss and primary patency was 100% at 30 days and 1 month. 2 and 3 year patency rates were 83% and 67% respectively.

CONCLUSIONS: Endovascular therapy for chronic, infra-renal aortic occlusion has a high technical success rate, low morbidity and mortality and short-term patency rates that are acceptable.