COMPLEX AORTOILIAC, PELVIC AND VISCERAL REVASCULARIZATION

Authors

  • António Pereira-Neves Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário São João, EPE, Porto, Portugal
  • João Rocha-Neves Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário São João, EPE, Porto, Portugal
  • Luís Duarte-Gamas Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário São João, EPE, Porto, Portugal
  • Alfredo Cerqueira Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário São João, EPE, Porto, Portugal
  • Ricardo Gouveia Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Vila Nova de Gaia/ Espinho, Vila Nova de Gaia, Portugal

DOI:

https://doi.org/10.48729/pjctvs.40

Abstract

Aortoiliac occlusive disease (AIOD) remains an area of debate concerning open and endovascular treatment options. A case of a 63-year old female is reported, with previous known vascular intermittent claudication, that presented in the emergency room with acute ischemia of the right lower limb with 24-hours of evolution. The computer tomographic angiography unveiled occlusion of the superior mesenteric artery, occlusion of left common iliac artery (CIA), subocclusive stenosis of right CIA, occlusion of distal runoffs vessels in the right lower limb and diffuse aorto-iliac disease. The first approach was to place the patient under catheter directed thrombolysis (48h) which led to right pedal pulse recovery but the occlusion of left CIA remained. The patient was then electively submitted to Covered Endovascular Repair of Aortic Bifurcation (CERAB) with chimney to inferior mesenteric artery and with an additional bailout left iliac sandwich due to dissection. Distal pulses are still present after 18 months of follow-up. Endovascular techniques provide a low morbimortality option with similar symptomatic improvement, challenging open surgery as the standard of care even in complex AIOD.

Downloads

Download data is not yet available.

References

Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45 Suppl S:S5-67.

Piffaretti G, Fargion AT, Dorigo W, Pulli R, Gattuso A, Bush RL, et al. Outcomes From the Multicenter Italian Registry on Primary Endovascular Treatment of Aortoiliac Occlusive Disease. J Endovasc Ther. 2019;26(5):623-32.

Mayor J, Branco BC, Chung J, Montero-Baker MF, Kougias P, Mills JL, Sr., et al. Outcome Comparison between Open and Endovascular Management of TASC II D Aortoiliac Occlusive Disease. Ann Vasc Surg. 2019;61:65-71 e3.

Sharma G, Scully RE, Shah SK, Madenci AL, Arnaoutakis DJ, Menard MT, et al. Thirty-year trends in aortofemoral bypass for aortoiliac occlusive disease. J Vasc Surg. 2018;68(6):1796-804 e2.

Psacharopulo D, Ferrero E, Ferri M, Viazzo A, Singh Bahia S, Trucco A, et al. Increasing efficacy of endovascular recanalization with covered stent graft for TransAtlantic Inter-Society Consensus II D aortoiliac complex occlusion. J Vasc Surg. 2015;62(5):1219-26.

Rocha-Neves J, Ferreira A, Sousa J, Pereira-Neves A, Vidoedo J, Alves H, et al. Endovascular Approach Versus Aortobifemoral Bypass Grafting: Outcomes in Extensive Aortoiliac Occlusive Disease. Vasc Endovascular Surg. 2020;54(2):102-10.

Indes JE, Pfaff MJ, Farrokhyar F, Brown H, Hashim P, Cheung K, et al. Clinical outcomes of 5358 patients undergoing direct open bypass or endovascular treatment for aortoiliac occlusive disease: a systematic review and meta-analysis. J Endovasc Ther. 2013;20(4):443-55.

DeCarlo C, Boitano LT, Schwartz SI, Lancaster RT, Conrad MF, Eagleton MJ, et al. Operative Complexity and Prior Endovascular Intervention Negatively Impact Morbidity after Aortobifemoral Bypass in the Modern Era. Ann Vasc Surg. 2020;62:21-9.

Mwipatayi BP, Sharma S, Daneshmand A, Thomas SD, Vijayan V, Altaf N, et al. Durability of the balloon-expandable covered versus bare-metal stents in the Covered versus Balloon Expandable Stent Trial (COBEST) for the treatment of aortoiliac occlusive disease. J Vasc Surg. 2016;64(1):83-94 e1.

Goverde PC, Grimme FA, Verbruggen PJ, Reijnen MM. Covered endovascular reconstruction of aortic bifurcation (CERAB) technique: a new approach in treating extensive aortoiliac occlusive disease. J Cardiovasc Surg (Torino). 2013;54(3):383-7.

Wohlauer M, Kobeiter H, Desgranges P, Becquemin JP, Cochennec F. Inferior Mesenteric Artery Stenting as a Novel Treatment for Chronic Mesenteric Ischemia in Patients with an Occluded Superior Mesenteric Artery and Celiac Trunk. Eur J Vasc Endovasc Surg. 2014;27(3):e21-e3.

Downloads

Published

17-04-2021

How to Cite

1.
Pereira-Neves A, Rocha-Neves J, Duarte-Gamas L, Cerqueira A, Gouveia R. COMPLEX AORTOILIAC, PELVIC AND VISCERAL REVASCULARIZATION. Rev Port Cir Cardiotorac Vasc [Internet]. 2021 Apr. 17 [cited 2024 May 21];27(3):231-3. Available from: https://pjctvs.com/index.php/journal/article/view/40

Issue

Section

Clinical Cases

Most read articles by the same author(s)