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    • Midterm Outcomes of Endovascular Treatment of TransAtlantic InterSociety Consensus Class C &D Aortoiliac Occlusion

    Ahmed El-Marakby¹, Ahmed Faragaly¹
    Assistant Professor in Vascular Surgery Department, General Surgery Division, Cairo University

    Objective: Management of TransAtlantic Inter-Society Consensus for the Peripheral Arterial Disease (TASC II) class C & D total aortoiliac occlusions is traditionally by open surgery. The aim of this study was to evaluate our centers’ outcomes treating TASC II C & D lesions by the endovascular approach. Methods: This is a retrospective review of all percutaneous interventions for TASC II type C & D aortoiliac occlusions performed between Jan 2012 and Dec 2015. Preoperative demographic data, risk factors for atherosclerosis, clinical symptoms, and postoperative follow-up were evaluated. Results: During this time period, 56 patients underwent endovascular repair for symptomatic TASC II type C & D aortoiliac occlusions. Primary technical success was achieved in all patients except one (98%) by percutaneous access via retrograde femoral approach. Additional brachial access in nine of these patients was performed. One patient (2%) had failed recanalization & converted to open surgery. Balloon and selfexpandable either bare metal (we used nitinol only) or covered stents were used. The balloon expandable covered stents were V12 (Atrium) and the self-expandable covered ones were the Viahaban (Gore) stents. Average intervention time was 111 minutes; with average 155 mL contrast was used. Minor postoperative complications were observed in 12 of 55 (21.8%) patients. Six patients (10.9%) had major complications that required interventions. We didn’t have any peri-intervetoinal mortality. Median length of stay was 2 days. The average follow-up was 10.0 months. Therapy failed in one patient at 20 months his leg became unsalvageable despite revascularization. Primary and secondary patency rates (at one year follow-up) were (48/55, 87.2%) and (50/55, 90.9%) respectively. Conclusions: An endovascular approach to complex total aortoiliac occlusions is feasible and shows promising midterm results with effective resolution of symptoms, low mortality rates, and short hospital stay according to this small series. Further prospective studies and longer-term follow-up are needed to confirm these results. 

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