New Era of Iliac Disease Management Using Balloon Expandable Covered Stent

Purpose:
To demonstrate the role of balloon expandable stents in the management of Aorto-Iliac artery disease; TASC C and D, and chronic total occlusions (CTO).

Material and Methods:
Material: 43 patients with CTO and TASC C and D lesions were treated with the Viabhan Ballon expandable stent (VBX) (W.L. Gore) and followed up for a 24-months. All of patients presented with Ruthford category > 3 (disabling claudication or ulcerations) and with back ground comorbidities that include hypertension, chronic renal failure, diabetes, cancer, cerebrovascular or myocardial disease. All patients previously smoked; with 3 current active smokers and 3 using e-cigarettes. All patients preferred endovascular treatment options with 86% of patients deemed unfit for open surgical repair. Methods: 86% of procedures were performed percutaneously under local anaesthesia , as a day case with patients discharged home the same day. 14% of patients with advanced occlusive disease required AUI construction with fem-fem crossover bypass graft. The endovascular procedures were performed by three experienced operators and the same type of stent was inserted into various lesion types, lengths and location within the aorto-iliac region, and the following configurations were applied depending on the pathology location; kissing iliac stents, AUI with fem-fem crossover bypass graft, single segment stent insertion (CIA/EIA), and full aorto-iliac construction. All patients post procedure were placed on dual anti-platelet therapy for 3 months.

Results:
100% technical success was recorded in all 43 patients in delivery and deployment of the stent with less than 30% residual stenosis. There were no intra-procedural complications of distal embolisation, dissections or rupture. 30-day post procedure follow up demonstrate 0% mortality, 0% graft occlusion and 0% related cardiac or cerebrovascular accidents. 24 months follow up demonstrate 0% amputation rate. 3 patients died following myocardial infraction >12 months post stent insertion. No evidence of stent graft occlusion was recorded, and patients remain symptom free with no progression to their previously treated CLI stage.

Conclusions:
There is a significant role for the use of balloon expandable covered stents in the treatment of aorta-iliac lesions TASC C, D and CTO, especially in patient unfit for open repair and bypass options.