48. OUTCOMES OF ENDOVASCULAR TREATMENT IN PATIENTS WITH CHRONIC OCCLUSIVE AORTOILIAC ARTERY DISEASE
Main Article Content
Abstract
Background: Incidence of chronic arterial occlusive disease in lower limbs is high in elder patients. Patients’ s chief complains are intermittent claudication, foot ulcer or even systemic sepsis. Typically, treatment of chronic arterial disease in lower limbs is arterial bypass surgery, endarterectomy. However, these are invasive surgeries, requiring general or spinal anesthesia. Recently, endovascular intervention techniques are applied to the treatment with benefits such as: local anesthesia, fewer complications, and feasible to elder patients with severe compromised disease.
Objective: To determine the efficacy of, results of endovascular treatment in patients with symptomatic chronic aortoiliac occlusive disease.
Methods: From June 2020 to April 2022, the prospective study was carried out on 56 cases with chronic aortoiliac occlusive disease, treated by PTA in Cardiovascular and Thoracic Department, Thong Nhat hospital.
Results: Majority of lesions belong to TASC II C (23%) and D (51%). The artery lesions included simple aortoiliac artery (23%), aortoiliac combined with femoropopliteal and/ or infrapopliteal artery (77%). The ankle- brachial index before and after the intervention is respectively 0.43 ± 0.3 and 0.76 ± 0.29 (p<0.001). Overall, the technical success rate was 96,4%. The complications included internal bleeding (1,8%), limb amputation (7,1%), contrast- induced acute kidney injury (1,8%). The primary patency of revascularization in 1 and 2-year is respectively 97,4% và 76,4%.
Conclusion: PTA is a feasible and effective procedure for treatment of lower limb artery disease. However, we need to increase the sample size and more study of long- term patency of PTA should be conducted.
Article Details
Keywords
peripheral artery disease, aortoiliac occlusive disease, chronic arterial occlusive disease
References
[2] Đinh Huỳnh Linh, Phạm Mạnh Hùng và cộng sự (2016). Đánh giá kết quả sớm can thiệp nội mạch điều trị bệnh động mạch chi dưới mạn tính ở Viện Tim mạch Việt Nam. Tạp chí Tim Mạch học Việt Nam, 75+76 (2016), 123-130.
[3] Klinkert P, Schepers A, Burger DH, et al. Vein versus polytetrafluoroethylene in above-knee femoropopliteal bypass grafting: five-year results of a randomized controlled trial. J Vasc Surg. 2003;37, 149 –155
[4] Kudo T, Chandra FA, Ahn SS. The effectiveness of percutaneous transluminal angioplasty for the treatment of critical limb ischemia: a 10-year experience. J Vasc Surg. 2005;41, 423– 435; discussion 435
[5] L’Italien GJ, Cambria RP, Cutler BS, et al. Comparative early and late cardiac morbidity among patients requiring different vascular surgery procedures. J Vasc Surg. 1995;21, 935–944.
[6] Marie D. Gerhard-Herman, et al, 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease. J Am Coll Cardiol. 2017 Mar, 69 (11), 71-126.
[7] Martin Schillinger, et al. Balloon Angioplasty versus Implantation of Nitinol Stents in the Superficial Femoral Artery. N Engl J Med 2006; 354, 1879-1888
[8] Mohammad Ali Husainy, OUTBACK catheter for treatment of superficial femoral and iliac artery chronic total occlusion: Experience from two centers. Indian J Radiol Imaging. 2016 AprJun; 26(2): 249–253.
[9] Murphy TP, et al.. Aortoiliac insufficiency: longterm experience with stent placement for treatment. Radiology. 2004;231, 243–249
[10] National Center for Health Statistics: NHANES 1999–2002: lower extremity disease examination (LEX), MEC examination. [accessed 21 October 2010]
[11] Nguyễn Lân Việt, Nghiên cứu mô hình bệnh tật ở bệnh nhân điều trị nội trú tại Viện Tim mạch Việt Nam trong thời gian 2003-2007. Tạp chí Tim mạch học Việt Nam, 2010. 52, 11-17.
[12] Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33
[13] Phạm Minh Ánh, Lê Đức Tín, Trương Thế Hiệp và cộng sự (2014). Đánh giá kết quả phẫu thuật kết hợp can thiệp nội mạch trong điều trị tắc động mạch mạn tính chi dưới. Nghiên cứu Y học Y Học TP. Hồ Chí Minh, 18(2), 223-228.
[14] Rutherford R B, Flanigan D P, Gupta S K. et al. Suggested standards for reports dealing with lower extremity ischemia. J Vasc Surg. 1986;4(1), 80–94.
[15] Victor Aboyans, Michael H. Criqui, et al. Measurement and Interpretation of the Ankle-Brachial IndexA Scientific Statement From the American Heart Association. Circulation, 16 Nov 2012, 126, 2890–2909
[16] Van den Akker PJ, van Schilfgaarde R, Brand R, et al. Aortoiliac and aortofemoral reconstruction of obstructive disease. Am J Surg. 1994;167:379–385.
[17] Ozkan U, Oguzkurt L, Tercan F. Technique, complication, and long-term outcome for endovascular treatment of iliac artery occlusion. Cardiovasc Intervent Radiol. 2010 Feb;33(1):18-24.
[18] Lakhter V, Aggarwal V. Current status and outcomes of iliac artery endovascular intervention. Interv Cardiol Clin. 2017;6(2):167–80.
[19] Zhang H, Li X, Niu L, Feng Y, Luo X, Zhang C, Zhang F. Effectiveness and long-term outcomes of different crossing strategies for the endovascular treatment of iliac artery chronic Total occlusions. BMC Cardiovasc Disord. 2020 Oct 2;20(1):431
[20] Vorwerk D, Guenther RW, Schu¨rmann K, Wendt G, Peters I (1995) Primary stent placement for chronic iliac artery occlusions: follow-up results in 103 patients. Radiology 194(3):745– 749
[21] Gandini R, Fabiano S, Chiocchi M, Chiappa R, Simonetti G (2008) Percutaneous treatment in iliac artery occlusion: longterm results. Cardiovasc Interv Radiol 31(6):1069–1076