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X-ray endovascular treatment of patients with stenotic-occlusive lesion of the aorto-iliac segment

https://doi.org/10.17238/2072-3180-2024-2-124-130

Abstract

Introduction. Chronic ischemia of the lower extremities is one of the most common manifestations of atherosclerotic disease in patients of the older age group. Stenotic-occlusive lesion of the aorto-iliac segment can be observed in more than 30 % of such patients. Currently, such patients can be treated by surgical methods (endarterectomy, aorto-iliac or aorto-femoral bypass surgery). Long-term postoperative studies show satisfactory results, but these operations are associated with a high risk of complications and mortality. Recently, there have been changes in views on approaches to the treatment of this pathology. Endovascular methods are becoming increasingly preferred, especially in elderly patients with severe concomitant pathology, even with extensive atherosclerotic vascular lesions.

Conclusion. Currently, given the tendency to increase the number of elderly patients with concomitant pathology, the occurrence of severe prolonged atherosclerotic disease, the use of endoprosthesis may be the preferred strategy, especially in highly calcified lesions, when there is an increased risk of vessel rupture. This is the safest and most effective method of revascularization.

About the Authors

М. Р. Chernyavin
Clinical Hospital № 1 (Volynskaya), Presidential Administration of the Russian Federation
Russian Federation

Chernyavin Maxim Pavlovich – Candidate of Medical Sciences, X-ray endovascular surgeon

Starovolynskaya street, 10, 121352, Moscow



Yu. V. Belov
Petrovsky National Research Centre of Surgery; I.M. Sechenov First Moscow State Medical University (Sechenov University) Ministry of Health of Russia
Russian Federation

Belov Yuri Vladimirovich – Director of the Institute of CardioAortic Surgery; Head of the Department of Hospital Surgery

Abrikosovsky per., 2, 119435, Moscow;

119048, Moscow



References

1. Aronow W.S., Ahn C., Gutstein H. Prevalence and incidence of cardiovascular disease in 1160 older men and 2464 older women in a longterm health care facility. J Gerontol A Biol Sci Med Sci., 2002, № 57(1), рр. M45–M46. https://doi.org/10.1093/gerona/57.1.m45

2. Sinyavin G.V., Vinokurov I.A., Mnatsakanyan G.V., Belov Yu.V. Epidemiology and pathogenesis of acute lower limb ischemia. Cardiology and cardiovascular surgery, 2019, № 12(4), рр. 291–295. (In Russ.)

3. Pokrovsky A.V., Abugov S.A., Alekyan B.G., Arakelyan V.S., Belov Yu.V., et al. National guidelines for the management of patients with diseases of the arteries of the lower extremities. The Russian conciliation document. Moscow, 2013. (In Russ.).

4. Belov Yu.V., Sinyavin G.V., Vinokurov I.A., Mnatsakanyan G.V. Particular aspects of acute ischemia of the lower extremities. Cardiology and cardiovascular surgery, 2019, № 12(6), рр. 564–567. (In Russ.)

5. Paisley M.J., Adkar S., Sheehan B.M., Stern J.R. Aortoiliac occlusive disease. Semin Vasc Surg., 2022, Jun; № 35(2), рр. 162–171. https://doi.org/10.1053/j.semvascsurg.2022.04.005

6. Krug R.T. , Calligaro K.D. , Dougherty M.J . Claudication in the young patient. Perspect Vasc Surg Endovasc Ther., 2000, № 13, рр. 27–38.

7. Selvin E., Erlinger T.P. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999–2000. Circulation, 2004, № 110(6), рр. 738–743. https://doi.org/10.1161/01.CIR.0000137913.26087.F0

8. Wooten C., Hayat M., du Plessis M. et al. Anatomical significance in aortoiliac occlusive disease. Clin Anat., 2014, № 27(8), рр. 1264–1274. https://doi.org/10.1002/ca.22444

9. Katsaros I., Georgakarakos E., Frigkas K. et al. Arterial collateral circulation pathways in patients with aortoiliac occlusive disease. Vascular, 2019, № 27, рр. 677–683.

10. Aboyans V., Ricco J.B., Bartelink M.E.L. et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Rev Esp Cardiol (Engl Ed), 2018, № 71(2), рр. 111. https://doi.org/10.1016/j.rec.2017.12.014

11. Fowler B., Jamrozik K., Norman P., Allen Y., Wilkinson E. Improving maximum walking distance in early peripheral arterial disease: randomised controlled trial. Aust J Physiother, 2002, № 48(4), рр. 269–275. https://doi.org/10.1016/s0004-9514(14)60166-5

12. Hess C.N., Norgren L., Ansel G.M. et al. A Structured Review of Antithrombotic Therapy in Peripheral Artery Disease With a Focus on Revascularization: A TASC (InterSociety Consensus for the Management of Peripheral Artery Disease) Initiative. Circulation, 2017, № 135(25), рр. 2534–2555. https://doi.org/10.1161/CIRCULATIONAHA.117.024469

13. Steffel J., Eikelboom J.W., Anand S.S., Shestakovska O., Yusuf S., Fox K.A.A. The COMPASS Trial: Net Clinical Benefit of Low-Dose Rivaroxaban Plus Aspirin as Compared With Aspirin in Patients With Chronic Vascular Disease Circulation, 2020, № 142(1), рр. 40–48. https://doi.org/10.1161/CIRCULATIONAHA.120.046048

14. CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet, 1996, № 348(9038), рр. 1329–1339. https://doi.org/10.1016/s0140-6736(96)09457-3

15. Zil-E-Ali A., Medina D., Orozco D., Yang Q., Aziz F. Preoperative Statin Use is Associated With Lower Incidence of Limb Loss After Lower Extremity Endovascular Interventions. Am Surg., 2022, № 88(11), рр. 2719–2729. https://doi.org/10.1177/00031348211068000

16. Norgren L., Hiatt W.R., Dormandy J.A. et al. Inter-society consensus for the management of peripheral arterial disease. Int Angiol., 2007, № 26(2), рр. 81–157.

17. Salem M., Hosny M.S., Francia F. et al. Management of Extensive Aorto-Iliac Disease: A Systematic Review and Meta-Analysis of 9319 Patients. Cardiovasc Intervent Radiol., 2021, № 44(10), рр. 1518–1535. https:// doi.org/10.1007/s00270-021-02785-6

18. Squizzato F., D’Oria M., Bozza R., Porcellato L., Grego F., Lepidi S.. Propensity-Matched Comparison of Endovascular versus Open Reconstruction for TASC-II C/D AortoIliac Occlusive Disease. A Ten-Year Single-Center Experience with Self-Expanding Covered Stents. Ann Vasc Surg., 2021, № 71, рр. 84–95. https://doi.org/10.1016/j.avsg.2020.08.139

19. Ye W., Liu C.W., Ricco J.B., Mani K., Zeng R., Jiang J. Early and late outcomes of percutaneous treatment of TransAtlantic Inter-Society Consensus class C and D aorto-iliac lesions. J Vasc Surg., 2011, № 53(6), рр. 1728–1737. https://doi.org/10.1016/j.jvs.2011.02.005

20. Bredahl K., Jensen L.P., Schroeder T.V., Sillesen H., Nielsen H., Eiberg J.P. Mortality and complications after aortic bifurcated bypass procedures for chronic aortoiliac occlusive disease. J Vasc Surg., 2015, № 62(1), рр. 75–82. https://doi.org/10.1016/j.jvs.2015.02.025

21. Khashram M., Williman J.A., Hider P.N., Jones G.T., Roake J.A. Systematic Review and Meta-analysis of Factors Influencing Survival Following Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg., 2016, № 51(2), рр. 203–215. https://doi.org/10.1016/j.ejvs.2015.09.007

22. Haimivici H., ed. Haimovici’s Vascular Surgery. 5th ed. Oxford, UK: Blackwell Publishing Ltd, 2004. https://doi.org/10.1002/9781118481370

23. Koizumi A., Kumakura H., Kanai H. et al. Ten-year patency and factors causing restenosis after endovascular treatment of iliac artery lesions. Circ J.. 2009, № 73(5), рр. 860–866. https://doi.org/10.1253/circj.cj-08-0765

24. Lakhter V., Aggarwal V. Current Status and Outcomes of Iliac Artery Endovascular Intervention. Interv Cardiol Clin., 2017, № 6(2), рр. 167–180. https://doi.org/10.1016/j.iccl.2016.12.001

25. Yang M., Zhang B., Niu G., Yan Z., Tong X., Zou Y. Long-term results of endovascular reconstruction for aortoiliac occlusive disease. Quant Imaging Med Surg, 2021, № 11(4), рр. 1303–1312. https://doi.org/10.21037/qims-20-599

26. Bosch J.L., Hunink M.G.M. Meta-analysis of the results of percutaneous transluminal angioplasty and stent placement of aortoiliac occlusive disease. Radiology, 1997, № 204, рр. 87–96.

27. Lammer J., Dake M.D., Bleyn J. et al. Peripheral arterial obstruction: prospective study of treatment with a transluminally placed selfexpanding stent-graft. International Trial Study Group. Radiology, 2000, № 217(1), рр. 95–104. https://doi.org/10.1148/radiology.217.1.r00se0595

28. Tomoi Y., Takahara M., Soga Y. et al. Clinical outcome of endovascular therapy using a VIABAHN VBX-covered stent for complex aortoiliac artery disease: the AVOCADO II study. Heart Vessels. 2023, № 38(10), рр. 1288–1297. https://doi.org/10.1007/s00380-023-02274-5

29. Maynar M., Reyes R., Ferral H. et al. Cragg Endopro-I: early experience in femoral arteries. J Vasc Interv Radiol, 1997, № 8, рр. 203–207.

30. Maldonado T.S., Westin G.G., Jazaeri O., Mewissen M., Reijnen M.M., Dwivedi A.J., Garrett H.E. Jr., Dias Perera A., Shimshak T., Mantese V., Smolock C.J., Arthurs Z.M. Treatment of Aortoiliac Occlusive Disease with the Endologix AFX Unibody Endograft. Eur J Vasc Endovasc Surg., 2016, Jul; № 52(1), рр. 64–74. https://doi.org/10.1016/j.ejvs.2016.04.003


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For citations:


Chernyavin М.Р., Belov Yu.V. X-ray endovascular treatment of patients with stenotic-occlusive lesion of the aorto-iliac segment. Moscow Surgical Journal. 2024;(2):124-130. (In Russ.) https://doi.org/10.17238/2072-3180-2024-2-124-130

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