Pepe Russell J, Patel Priya, Huntress Lauren A, Nassiri Naiem
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Division of Vascular Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ.
Ann Vasc Surg. 2017 Nov;45:263.e11-263.e17. doi: 10.1016/j.avsg.2017.06.053. Epub 2017 Jun 23.
According to the 2007 TransAtlantic Inter-Society Consensus (TASC II) guidelines, surgery is the preferred treatment for extensive (TASC II type C and D) aortoiliac occlusive disease (AIOD). Recent studies, however, have shown that endovascular management can be an effective first-line treatment option for TASC II type C and D categories. While endovascular therapy is now commonly performed in patients with TASC II type D lesions, very few studies have investigated the feasibility and effectiveness of extending endovascular therapy to the most severe subcategory of TASC II D lesions, chronic infrarenal aortoiliac occlusion (CIAO). Herein, we present our technique for endovascular treatment of CIAO which relies on bidirectional subintimal aortoiliac dissection, wire snare for true lumen reentry, and combined balloon-expandable and self-expanding covered stent reconstruction of the aortic bifurcation and bilateral iliac arteries. This technique safely extends the reach of endovascular therapy to the most severe subcategory of TASC II D AIOD, CIAO. It is a viable minimally invasive alternative to aortobifemoral bypass surgery. Long-term follow-up of larger cohorts is needed to verify clinical efficacy and durability of therapy.
根据2007年跨大西洋跨学会共识（TASC II）指南，手术是广泛型（TASC II C型和D型）主髂动脉闭塞性疾病（AIOD）的首选治疗方法。然而，最近的研究表明，血管内治疗对于TASC II C型和D型疾病可以作为一种有效的一线治疗选择。虽然血管内治疗目前常用于TASC II D型病变患者，但很少有研究探讨将血管内治疗扩展到TASC II D型病变最严重的亚类——慢性肾下腹主动脉髂动脉闭塞（CIAO）的可行性和有效性。在此，我们介绍我们用于CIAO血管内治疗的技术，该技术依赖于双向内膜下主髂动脉夹层分离、真腔重新进入的钢丝圈套器，以及主动脉分叉和双侧髂动脉的球囊扩张式和自膨式覆膜支架联合重建。该技术安全地将血管内治疗的范围扩展到TASC II D型AIOD最严重的亚类CIAO。它是主动脉双股动脉搭桥手术可行的微创替代方案。需要对更大队列进行长期随访以验证治疗的临床疗效和持久性。
