Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists
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Multicenter Study Observational Study
Outcomes From the Multicenter Italian Registry on Primary Endovascular Treatment of Aortoiliac Occlusive Disease.
Purpose: To report the results of endovascular treatment of iliac and complex aortoiliac occlusive disease (AIOD) in a multicenter Italian registry. Materials and Methods: A retrospective, multicenter, observational cohort study analyzed 713 patients (mean age 68±10 years; 539 men) with isolated iliac and complex aortoiliac lesions treated with primary stenting between January 2015 and December 2017. Indications for treatment were claudication in 406 (57%) patients and critical limb ischemia in 307 (43%). ⋯ Chronic obstructive pulmonary disease was associated with decreased primary patency (HR 3.7, 95% CI 1.25 to 10.8, p=0.018). Conclusion: Endovascular intervention with primary stent placement for aortoiliac occlusive disease achieved satisfactory 2-year patency regardless of the complexity of the lesion. Almost all TASC lesions should be considered for primary endovascular intervention if suitable.
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Purpose: To evaluate outcomes of homemade fenestrated stent-grafts for complete endovascular aortic repair of aortic arch dissections. Materials and Methods: From July 2014 through September 2018, 35 patients (mean age 66±11 years; 25 men) underwent homemade fenestrated stent-graft repair of acute (n=16) or chronic (n=10) complicated type B aortic dissections (n=16) and dissecting aortic arch aneurysms subsequent to surgical treatment of acute type A dissections (n=9). Nineteen (54%) procedures were emergent. ⋯ All supra-aortic trunks were patent. Conclusion: The use of homemade fenestrated stent-grafts for endovascular repair of aortic arch dissections is feasible and effective for total endovascular aortic arch repair. Durability concerns will need to be assessed in additional studies with long-term follow-up.
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Purpose: To report a candy-plug technique using a Zenith Alpha stent-graft to occlude the distal false lumen in a patient with a complicated chronic type B aortic dissection. Case Report: A 50-year-old male smoker presented with chest pain due to rapidly growing complicated chronic type B aortic dissection. Computed tomography angiography (CTA) showed the dissection extending from distal to the origin of the left subclavian artery (LSA) down to the left femoral artery. ⋯ A gutter leak and a type Ia endoleak were embolized via a left brachial artery approach. At 2.5 years, imaging showed the candy plug in position, no endoleak, and the thrombosed false lumen in the thoracic aorta reduced in size. Conclusion: The candy-plug technique is useful in facilitating complete occlusion of the false lumen in chronic aortic dissection, which avoids an open procedure and the risk of higher morbidity.