A systematic review of endovascular treatment of extensive aortoiliac occlusive disease

Abstract

Objectives: Current multidisciplinary guidelines recommend to treat extensive aortoiliac occlusive disease (AIOD) by surgical revascularization. Surgery provides good long-term patency, but at the cost of substantial perioperative morbidity. Development of new technologies and techniques has led to increased use of endovascular therapy for extensive AIOD. We performed a systematic review of the literature to determine contemporary short- and long-term results of endovascular therapy for extensive AIOD.

Methods: The Medline, Embase, and Cochrane databases were searched to identify all studies reporting endovascular treatment of extensive AIOD (TransAtlantic Inter-Society Consensus (TASC) type C and D) from January 2000 to June 2009. Two independent observers selected studies for inclusion, assessed the methodologic quality of the included studies, and performed the data extraction. Outcomes were technical success, clinical success, mortality, complications, long-term primary, and secondary patency rates.

Results: Nineteen nonrandomized cohort studies reporting on 1711 patients were included. There was substantial clinical heterogeneity between the studies considering study population and interventional techniques. Technical success was achieved in 86% to 100% of the patients. Clinical symptoms improved in 83% to 100%. Mortality was described in seven studies and ranged from 1.2% to 6.7%. Complications were reported in 3% to 45% of the patients. Most common complications were distal embolization, access site hematomas, pseudoaneurysms, arterial ruptures, and arterial dissections. The majority of complications could be treated using percutaneous or noninvasive techniques. Four- or 5-year primary and secondary patency rates ranged from 60% to 86% and 80% to 98%, respectively.

Conclusions: Endovascular treatment of extensive AIOD can be performed successfully by experienced interventionists in selected patients. Although primary patency rates are lower than those reported for surgical revascularization, reinterventions can often be performed percutaneously, with secondary patency comparable to surgical repair.