Endovascular Approach in Critical Limb Ischemia of TASC II C and D Aorto-iliac Lesions

Simon Papoyan ¹, Alexandr Schegolev ², Alexandr Mitichkin ¹, Maxim Sazonov ¹

¹ Inozemtcev Moscow Municipal Hospital, Moscow, Russia; ² Pirogov Russian National Research Medical University , Moscow, Russia;

Date, time and location: 2018.05.26 08:30, Exhibition area, 1st Floor. Zone – A

Abstract

Objective:This study was aimed to  shows the effectiveness of endovascular interventions in patients with types C and D TASC II classification.

Materials and Methods

This is a prospective study of 45 patients with symptomatic chronic atherosclerotic lower limb ischemia with Chronic total occlusion (CTO) iliac disease.  The population consisted of 38 male and 7 female patients. Average age 60 years old.

Limb ischemia symptoms were stratified into rest pain (78,8%), and tissue loss (gangrene or ulceration) (21,2%). Before surgery the mean value of ABI was 0.28. According to the TASC-II classification, 17 had TASC type C, and 28 patients had TASC D.

Results

Technical success was 100% in TACS C and 92% in TASC D was confirmed by clinical assessment of distal pulsations.

Two patients with lesions of type D, initially failed to recanalizing occluded areas . Bypass surgery was performed in these cases. An ischemia symptom was regressed in all patients. The mean ABI increased from 0.45 to 0.83 after successful treatment.

One patient developed brachial thrombosis after sheath removal, which was managed, and three patients developed groin hematoma that was managed conservatively. In 1 case was observed extravasation of contrast in the region of the external iliac artery, successfully eliminated by additional stent implanting, in the second case we observed embolism in the contralateral iliac artery, was successfully resolved by open surgery. There was no mortality related to the intervention.

Patency rateOne year follow-up was obtained in all patients, the patency of the iliac arteries was 93,3%. 

Conclusion

Endovascular treatment for iliac artery occlusive disease can be considered an alternative to open surgery for TASC-II C, D  disease, especially in surgically unfit patients or those who refuse surgical intervention, and kissing stenting is a safe procedure.