Endovascular management of total juxtarenal aortic occlusive disease in high-risk patients: technical considerations and clinical outcome.

Background: To report our single-center experience in the endovascular treatment of juxtarenal aorto-iliac occlusions.

Methods: Between December 2008 and December 2012, 13 patients with total juxtarenal aorto-iliac occlusion, considered at high risk for open revascularization, were treated by endovascular means at our Department. Inclusion criteria were severe intermittent claudication, rest pain and distal tissue loss. Antegrade recanalization from percutaneous brachial access and retrograde angioplasty and stenting from percutaneous or surgical femoral accesses were performed. The renal arteries (RAs) were protected using filters or balloons. Aorto-iliac bare-metal stents were deployed in all patients.

Results: No death was registered. Technical success was 100%. In 11 patients (84.6%) the Ankle-Brachial Index increased to 0.9-1. Renal arteries were involved in 7 cases (53.8%): 3 chimney stent grafts deployment, 2 aorto-iliac stent fenestrations and 2 aorto-iliac stents placement above the renal arteries without renal function impairment. Complication rate was 38.5%: 2 cases of thrombus dislodgement into the RAs, 1 distal artery embolization, 1 common iliac artery rupture and 1 pseudo-aneurysm. All complications were treated percutaneously, except for the distal embolization treated surgically. The patient with iliac artery rupture underwent acute renal insufficiency requiring temporary dialysis after hemorrhagic shock because of retroperitoneal hematoma. Mean follow-up was 18 months (range 6-30 months). The primary and secondary patency was respectively 92.3% and 100%.

Conclusion: Endovascular recanalization of juxtarenal aorto-iliac occlusion in selected patients is feasible and safe, with good early and mid-term results and should be considered in high risk patients.