Background: Aortoiliac arterial occlusive disease (AIOD) is one of the commonest patterns of
systemic atherosclerosis with a spectrum of chronic symptoms from intermittent claudication
to critical limb ischemia, which is a common therapeutic challenge. A meaningful shift
has evolved in treating symptomatic AIOD from open to endovascular repair, which are
becoming an attractive treatment option even in complex lesions, especially in patients
with considerable risk. The aim of this study was to assess the feasibility, that
is, technical success rates, primary patency, and safety outcome for Trans-Atlantic
Inter-Society Consensus (TASC) D lesions treated endovascularly with analysis of outcome
of stent graft versus bare metal stent in patients with advanced Leriche syndrome.
Method(s): A prospective case series study: over 30 months, our case study was conducted on
22 patients with TASC D lesion morphology undergoing treatment for symptomatic chronic
AIOD at the Vascular Unit, General Surgery Department, Benha University Hospitals,
Vascular Surgery Department, Nile Insurance Hospital and Vascular Surgery Department,
Security Forces Hospital and Al-Noor Specialist Hospital, Makkah, Saudi Arabia. The
patients were enrolled from April 2015 until October 2016 with a 12-month follow-up
period from the last patient enrolled. SPSS, version AQ8 20.0 for Windows was used
for statistical analysis. Result(s): Our study had a technical success rate of 95.5% in crossing TASC D lesion with immediate
angiographic success (91%). The 12-month primary patency rate was 85% for TASC D lesions
with a target lesion revascularization of 15%. Stent grafts had a higher 1-year patency
rate (91.7%) versus bare metal stent (75%). The total procedure-related complications
rate was 18.1% and 30 days procedure-related mortality was 4.7%. Conclusion(s): Our study shows that technical success of endovascular therapy for TASC D lesions
was 95.5% with a 1-year primary patency of 85% and a complication rate of 22.7% in
TASC D lesions. Utilizing more than one access with antegrade crossing the lesion
through brachial access was paramount for technical success. Long-term follow-up is
mandatory to support the durability of the procedure.
