Aortoiliac occlusive disease: open or endo? – a narrative review
Keywords:Aortoiliac occlusive disease, Endovascular repair, Aortobifemoral bypass, Stent, Open surgical repair
INTRODUCTION: Aortoiliac occlusive disease (AIOD) can be treated using either open surgical revascularization (OSR) or endovascular revascularization (ER).
METHODS: A Medline search was performed in order to identify articles focused on the treatment of aortoiliac occlusive disease. Additional articles of scientific interest for the purpose of this non-systematic review were included by cross-referencing.
RESULTS: There are a few articles reporting direct results between both techniques based on retrospective or prospective single center or multicenter studies. In the majority of studies, primary patency is generally better for surgery in comparison to ER, but at a cost of more postoperative complications, with higher rates of respiratory failure and wound infection in the open group. On the other hand, endovascular recanalization is related to higher rates of limb ischemia/thrombosis, renal dysfunction and reinterventions. In the presence of femoral artery calcified disease, the hybrid approach should be considered.
CONCLUSIONS: Endovascular treatment is a suitable alternative for extensive AIOD and can be accomplished in a less invasive manner, with most midterm outcomes comparable with open reconstruction. Surgery should be reserved for multilevel calcified disease and after endovascular failure.
Indes J, Miles J, Forough F, Hillary B, Peter H, Kevin C, et al. Clinical Outcomes of 5358 Patients Undergoing Direct Open Bypass or Endovascular Treatment for Aortoiliac Occlusive Disease. J Endovasc Ther 2013;20:443–455
Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. Jan 2007;45 Suppl S:S5-67.
Aboyans V, Ricco JB, Bartelink MEL, et al. 2017 ESC Guidelnes on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. Mar 1 2018;39(9):763-816.
Sidawy A, Rutherford's Vascular Surgery and Endovascular Therapy 9th edition. 2019; section 15:1397-1437
Sen I, Stephen E, Agarwal S. Clinical profile of aortoiliac occlusive disease and outcomes of aortobifemoral bypass in India. J Vasc Surg. Feb 2013;57(2 Suppl):20S-5S.
Jebbink E, Mathai V, Boersen J, Sun C, Slump C, Goverde P. Hemodynamic comparison of stent configurations used for aortoiliac occlusive disease. Journal of Vascular Surgery 2016; 1-10.
Kuffer D, Soengel F, Steckmeier B. Percutaneous Reconstruction of the Aortic Bifurcation with Palmaz Stents: Case Report. Cardio Intervent Radiol 1991; 14:170-172
Palmaz JC, Encarnacion CE, Garcia OJ, et al. Aortic Bifurcation Stenosis: Treatment with Intravascular Stents. Journal of Vascular and Interventional Radiology. 1991;2(3):319-323.
Groot Jebbink E, Grimme FA, Goverde PC, van Oostayen JA, Slump CH, Reijnen MM. Geometrical consequences of kissing stents and the Covered Endovascular Reconstruction of the Aortic Bifurcation configuration in an in vitro model for endovascular reconstruction of aortic bifurcation. J Vasc Surg. May 2015;61(5):1306-11.
Mwipatayi BP, Sharma S, Daneshmand A, 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. Jul 2016;64(1):83-94 e1.
Piazza M, Squizzato F, Dall'Antonia A, et al. Editor's Choice - Outcomes of Self Expanding PTFE Covered Stent Versus Bare Metal Stent for Chronic Iliac Artery Occlusion in Matched Cohorts Using Propensity Score Modelling. Eur J Vasc Endovasc Surg. Aug 2017;54(2):177-185.
Horejs D, Gilbert P, Burstein S, Vogelzang R. Normal Aortoiliac Diameters by CT. Journal of Computer Assisted tomography 1988; 12(4):602-603
Kokkinidis D, Alvandi B, Hossain P, Foley T, Kielhorn C, Singh G, et al. Midterm Outcomes After Endovascular Intervention for Occluded vs Stenosed External Iliac Arteries. Journal of Endovasc Ther 2018; 25(2):183-191
Pescatori LC, Tacher V, Kobeiter H. The Use of Re-entry Devices in Aortoiliac Occlusive Disease. Front Cardiovasc Med. 2020;7:144.
Sachwani G, Hans S, Khoury M, King T, Mitsuya M, Rizk Y, et al. Results of iliac stenting and aortofemoral grafting for iliac artery occlusions. J Vasc Surg 2013;57:1030-7
Dorigo W, Piffaretti G, Benedetto F, Tarallo A, Castelli P, Spinelli F, et al. A comparison between aortobifemoral bypass and aortoiliac kissing stents in patients with complex aortoiliac obstructive disease. J Vasc Surg 2016;1-9
Mayor J, Branco B, Chung J, Montero-Baker M, Kougias P, et al. Outcome Comparison between Open and Endovascular Management of TASC II D Aortoiliac Occlusive Disease. Annals of Vascular Surgery 2019
Kashyap VS, Pavkov ML, Bena JF, et al. The management of severe aortoiliac occlusive disease: endovascular therapy rivals open reconstruction. J Vasc Surg. Dec 2008;48(6):1451-7, 1457 e1-3.
Starodubtsev V, Karpenko A, Ignatenko P. Hybrid and open surgery of Trans-Atlantic Inter-Society II type C and D iliac International angiology: a journal of the International Union of Angiology 2015