Endovascular reconstruction of the aortic bifurcation in patients with Leriche syndrome

Abstract

Background: The Leriche syndrome with contiguous total occlusions of the infrarenal aorta and the iliac arteries is a variant of Trans-Atlantic Inter-Society Consensus (TASC) type D aortoiliac disease, for which surgery is the recommended treatment of choice. We sought to prospectively assess the feasibility and safety of an endovascular therapeutic approach.

Methods: Eleven consecutive patients with Leriche syndrome (eight men; 64 +/- 12 years) constituted the study cohort. The treatment strategy consisted of recanalization by transbrachial access of the occluded segments and subsequent transfemoral angioplasty with selective stent placement in the distal aorta and primary nitinol stent placement in the iliac arteries.

Results: Bilateral endovascular success was achieved in eight patients (73%), unilateral success in the other three patients. Seven patients received aortic stents; the total stented segment length in 19 iliac arteries successfully recanalized amounted to a median of 18 cm (range 12-26 cm). There was one periprocedural complication, an acute thrombotic aortoiliac occlusion managed by thrombolysis. One patient with unilateral endovascular success had to undergo femorofemoral crossover bypass grafting. At a median of 14 months, significant hemodynamic improvement was observed in successfully revascularized legs (ankle-brachial index, 0.79 +/- 0.20 vs. 0.48 +/- 0.08 at baseline; P = 0.0004); walking capacity as well as Rutherford category of peripheral arterial disease had improved in all patients.

Conclusions: In this small series of patients with Leriche syndrome, the reconstruction of the totally occluded aortoiliac bifurcation by endoluminal means was shown to be feasible and safe and associated with excellent mid-term clinical outcomes.