Aortic bifurcation reconstruction: Use of the memotherm self-expanding nitinol stent for stenoses and occlusions

Purpose: To assess the technical success, initial clinical outcome, and int ermediate follow-up of the Memotherm nitinol self-expanding stent in aortic bifurcation reconstruction. Methods: Thirty-three patients (13 male, 20 female), mean age 64 years, wer e treated, who had symptoms classified by the Surgical Vascular Society/Int ernational Society of Cardiovascular Surgery (SVS/ICVS) classification as g rade 2 in 11 (33%), grade 3 in 19 (58%) and grade 4 in 3 (9%) patients. Les ions were classified according to severity and type. Indications for placem ent of a Memotherm nitinol self-expanding stent were failed angioplasty in 14 (42%), chronic occlusions in 12 (37%), and complex stenoses in seven (21 %) patients. Results: Sixty-seven stents were technically successfully placed in 66 aort o-iliac segments in 33 patients, with one major complication. Initial clini cal outcome was improvement in 25 (81%), no change in four (13%), and a wor sening in two (6%) patients by Rutherford criteria. Mean early ankle/brachi al pressure index (ABI) gain was 0.27 for occlusions and 0.05 for stenoses. Clinical follow-up was obtained in all patients, with retrospective angiog raphic follow-up in 28 (85%) at a mean of 16 months (range 12-26 months). T he decrease in ABI and the decrease in angiographic luminal diameter at fol low-up was determined as the "late loss." The mean ABI late losses were -0. 06, 0.00, and 0.09, and the mean angiographic late losses were 6.7%, 10% an d 14% for occlusions, stenoses, and normal segments respectively. Primary c linical patency was 96%, primary angiographic patency was 89%, and secondar y angiographic patency was 93%. Conclusion: The high technical success of stent placement, the low complica tion rates for aortic bifurcation reconstruction using the Memotherm self-e xpanding stent, and high clinical and angiographic patency maintained at in termediate follow-up support their use in aortic bifurcation reconstruction .