Objectives: Retrospectively analyzed the clinical outcomes of endovascular reconstruction of chronic juxtarenal aortoiliac occlusive disease (AIOD) .
Methods: All patients with juxtarenal AIOD who received endovascular therapy from Jan. 2016 to Dec. 2022 were continuously reviewed. Relevant clinical and baseline data, surgical methods and primary patency were analyzed. Endovascular reconstruction were performed by bilateral femoral or combined brachial artery percutaneous access. Catheter directed thrombolysis (CDT) was performed in part cases and kissing covered stents (KCSs) were implanted to reconstruct aortoiliac artery. One-stage reconstruction were performed by KCSs in condition of performing protective renal artery balloon(s) in advance. If the CDT failed, renal arterial chimney stent(s) was used to extend the anchor area of KCSs to the suprarenal aorta. When the lesions involved the common iliac artery bifurcation and extended into the external iliac artery (EIA), an additional CS or bare metal stent (BMS) was implanted into the EIA to preserve at least one lateral internal iliac artery. Common femoral artery (CFA) endarterectomy was performed simultaneously while CFA involved. All patients were given dual antiplatelet therapy for 3 to 6 months after surgery, followed by long-term single antiplatelet therapy.
Results: 14 patients with juxtarenal AIOD were treated by using KCSs reconstruction of aortoiliac artery in this study. CDT were performed in 6 patients and 6 planned or bailed-out renal stents were implanted in 5 patients. Hybrid procedure were performed in 1 patient. Surgical success rate was 100%, early ( < 30-day) mortality rates was 0%. The thrombus dislodged into the renal artery happened in two cases during procedure of balloon dilatation and stents deployment and remedied by intraoperative thrombectomy. Acute renal stent thrombosis occured in one case 24 hours later after operation because of its slimmer caliber, an additional larger diameter BMS was implanted after 6-hours of CDT. One case of left iliac artery stent thrombosis happened 12 days after aortoiliac reconstruction and recanalization by means of CDT and an extended stent implantation. The primary patency rate during 3-year follow-up was 92.9% (13/14), assisted primary patency rate was 100% (1/1). Mean postoperative ankle-brachial index (ABI) increase 0.67±0.26.
Conclusions: An endovascular revascularization is an effective therapy for chronical juxtarenal AIOD. CDT has been accepted as the optional initial method to provide more anchor room for implanting KCSs, and chimney renal artery stent(s) could be used in case of CDT failed patients.
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