A study on surgical intervention outcomes in chronic aorto iliac occlusion
DOI:
https://doi.org/10.18203/2349-2902.isj20185027Keywords:
Angiogram of aorto with bilateral lower limb, Chronic aorto iliac occlusion, Hypertension, SmokingAbstract
Background: Aorto-iliac occlusion is an advanced and late manifestation of the atherosclerotic vascular disease. Patients with this complicated and frequently multi-level disease can present with debilitating symptoms ranging from life-limiting claudication to limb-threatening ischemia. To study the results of Surgical management and complications of Aortic surgery in a patient with chronic, aortoiliac occlusion.
Methods: Our study of 22 cases, 12 patient underwent aortic bi femoral bypass, 08 cases underwent aortobi-iliac bypass and 2 of them aortic endarterectomy. This entire patient had a 64 slice CT angiogram of aorto with bilateral lower limb and offered surgical treatment after explaining the risk and complication of surgery. All patients followed post op with the clinical examination, ABI, duplex once a month.
Results: 19 patients had a patent graft at the end of the study period. The primary patency of 86%. 2 patient had graft thrombectomy, 1 patient had graft thrombectomy with extension bypass, hence the secondary patency was 95%.
Conclusions: The spectrum of aortoiliac occlusive disease ranges from short, simple stenosis to long, complete occlusions, with treatment options that vary accordingly from minimally invasive endovascular procedures to major open surgical intervention.
References
Babu SC, Shah PM, Nitahara J. Acute aortic occlusion–factors that influence the outcome. J Vasc Surg. 1995;21(4):567-72.
Chiesa R, Marone EM, Tshomba Y, Logaldo D, Castellano R, Melissano G. Aortobifemoral bypass grafting using expanded polytetrafluoroethylene stretch grafts in patients with the occlusive atherosclerotic disease. Ann Vasc Surg. 2009;23(6):764-9.
Crawford JD, Perrone KH, Wong VW, Mitchell EL, Azarbal AF, Liem TK, et al. A modern series of acute aortic occlusion. J Vasc Surg. 2014;59(4):1044-50.
De Vries SO, Hunink MG. Results of aortic bifurcation grafts for aortoiliac occlusive disease: a meta-analysis. J Vasc Surg. 1997;26(4):558-69.
Eldrup-Jorgensen J, Flanigan DP, Brace L, Sawchuk AP, Mulder SG, Anderson CP, et al. Hypercoagulable states and lower limb ischemia in young adults. J Vasc Surg. 1989;9(2):334-41.
Hans SS, DeSantis D, Siddiqui R, Khoury M. Results of endovascular therapy and aortobifemoral grafting for Transatlantic Inter-Society type C and D aortoiliac occlusive disease. Surgery. 2008;144(4):583-90.
Hardman RL, Lopera JE, Cardan RA, Trimmer CK, Josephs SC. Common and rare collateral pathways in aortoiliac occlusive disease: a pictorial essay. AJR Am J Roentgenol. 2011;197(3):W519-24.
Indes JE, Mandawat A, Tuggle CT, Muhs B, Sosa JA. Endovascular procedures for the aortoiliac occlusive disease are associated with superior short-term clinical and economic outcomes compared with open surgery in the inpatient population. J Vasc Surg. 2010;52(5):1173-9.
Jongkind V, Akkersdijk GJM, Yeung KK, Wisselink W. A systematic review of endovascular treatment of extensive aortoiliac occlusive disease. J Vasc Surg. 2010;52(5):1376-83.
Kashyap VS, Pavkov ML, Bena JF, Sarac TP, O'Hara PJ, Lyden SP, et al. The management of severe aortoiliac occlusive disease: endovascular therapy rivals open reconstruction. J Vasc Surg. 2008;48(6):1451-7.
Kim T-H, Ko Y-G, Kim U, Kim JS, Choi D, Hong MK, et al. Outcomes of endovascular treatment of chronic total occlusion of the infrarenal aorta. J Vasc Surg. 2011;53(6):1542-9.
Kim U, Hong S-J, Kim J, Kim JS, Ko YG, Choi D, et al. Intermediate to long-term outcomes of endoluminal stent-graft repair in patients with chronic type B aortic dissection J Endovasc Ther. 2009;16(1):42-7.
Leriche R. De la résection du carrefour aortico-iliaque avec double sympathectomie lombaire pour thrombose artéritique la l'aorte: le syndrome de l'oblitération termino-aortique parartérite. Presse Med. 2004;48:601-7.
Leville CD, Kashyap VS, Clair DG, Bena JF, Lyden SP, Greenberg RK, et al. Endovascular management of iliac artery occlusions: extending treatment to TransAtlantic Inter-Society Consensus class C and D patients. J Vasc Surg. 2006;43(1):32-9.
Moise MA, Alvarez-Tostado JA, Clair DG. Endovascular management of chronic infrarenal aortic occlusionogy in health care: the case of aorto-iliac occlusive disease. J Endovasc Ther. 2009;16(1):84-92.
Rosfors S, Eriksson M, Höglund N, Johansson G. Duplex ultrasound in patients with suspected aorto-iliac occlusive disease. Eur J Vasc Surg. 1993;7(5):513-7.
Sixt S, Krankenberg H, Möhrle C, Kaspar M, Tübler T, Rastan A, et al. Endovascular treatment for extensive aortoiliac artery reconstruction: a single-center experience based on 1712 interventions. J Endovasc Ther. 2013;20(1):64-73.
Timaran CH, Prault TL, Stevens SL, Freeman MB, Goldman MH. Iliac artery stenting versus surgical reconstruction for TASC (TransAtlantic Inter-Society Consensus) type B and type C iliac lesions. J Vasc Surg. 2003;38(2):272-8.
Upchurch GR, Dimick JB, Wainess RM, Eliason JL, Henke PK, Cowan JA, et al. Diffusion of new technology in health care: the case of the aortoiliac occlusive disease. Surgery. 2004;136(4):812-8.
West CA, Johnson LW, Doucet L, Caldito G, Heldman M, Szarvas T, et al. A contemporary experience of open aortic reconstruction in patients with chronic atherosclerotic occlusion of the abdominal aorta. J Vasc Surg. 2010;52(5):1164-72.