Endovascular treatment of complex atherosclerotic lesions of the aortoiliac segment

Aim. Endovascular surgery is the first choice method for the treatment of iliac occlusive lesions. Its role in complex lesions of the aortic bifurcation and terminal aorta is still debated. The aim of this retrospective study is to analyze the treatment outcomes in a group of patients. Methods. Forty-two consecutive patients who underwent an aortoiliac bilateral endovascular procedure between January 1994 and December 2001 were analyzed. The patient population was subdivided into 4 groups according to the Trans-Atlantic Inter-Society Consensus (TASC) 2001 criteria. Twelve patients with type A lesions, 2 with type B, 4 with type C, and 24 with type D were treated. Stents were placed in 26 patients. Results. Global early patency was 100%, 1-year patency 91%, and 5-patency 79%. In the group with the largest lesions (type D), early patency was 100%, 1-year patency 91%, and 5-patency 65%. In the group with stent placement, early patency was 100%, 1-year patency 91.6%; this value remained unchanged at 5-year follow-up but was not statistically significant. Conclusion. Endovascular surgery appears to be a valuable treatment option also in bilateral lesions of the iliac-femoral axis and/or those involving the aortic bifurcation and terminal aorta. Failed treatment attempts doe not preclude eventual conversion to conventional revascularization with abdominal or extra-anatomic access.