Primary stenting in infrarenal aortic occlusive disease

Purpose: To evaluate the results of primary stenting in aortic occlusive di sease. Methods: Thirty patients underwent primary stenting of focal concentric (n = 2) and complex aortic stenoses (n 19), and aortic or aorto-iliac occlusio ns (n = 9); Sixteen patients underwent endovascular outflow procedures, thr ee of whom also had distal open surgical reconstructions. Median follow-up was 16 months (range 1-60 months). Results: Guidewire crossing of two aorto-biiliac occlusions failed, resulti ng in a 93% (28/30) technical success. Major complications included one acc ess hematoma, one myocardial infarction, one death (recurrent thromboemboli sm) in a patient with widespread malignancy, and one fatal hemorrhage durin g thrombolysis of distal emboli from a recanalized occluded iliac artery. O ne patient did not improve his symptoms, resulting in a 1-month clinical su ccess of 83% (25/30). Following restenting the 26 stented survivors changed their clinical limb status to +3 (n = 17) and +2 (n = 9). During follow-up one symptomatic aortic restenosis occurred and was successfully restented. Conclusions: Primary stenting of complex aortic stenoses and short occlusio ns is an attractive alternative to conventional surgery. Larger studies wit h longer follow-up and stratification of lesion morphology are warranted to define its role relative to balloon angioplasty. Stenting of aorto-biiliac occlusions is feasible but its role relative to bypass grafting remains to be defined.