Increased Role Of Endovascular/Hybrid Procedures In the Management Of Complex (TASC C/D) Aortoiliac Occlusive Disease

Introduction: Increased use of endovascular/hybrid procedures has resulted in a dramatic decrease of open procedures performed for TASC C/D aortoiliac occlusive disease. We analyzed the change of our practice and patient outcomes over the last 5 years.
Methods: Consecutive patients who were treated for TASC C/D aortoiliac disease between 06/01-09/03(Group I) and 10/03-03/06(Group II) by OPEN, percutaneous(ENDO) or complex HYBRID procedures were analyzed.
Results: A total of 75 patients were treated(mean age 65.4+10.0, Group I=30, Group II=45). Presenting symptoms(40% claudicants), age, co-morbidities were similar. Decrease in aortobifemoral bypass(23%vs4%), extraanatomic bypass(77%vs18%), and increase in complex endovascular reconstructions (0% vs 44% ENDO, 34% HYBRID) were significant(P<0.05). Length of stay(LOS) decreased from 7.3+6.2 to 4.9+5.3 days(NS). 30-month primary(PP, 64%vs92%, p=0.01) and assisted primary(APP, 71%vs92%; p=0.045) patencies were significantly better in Group II than I, whereas secondary patency(SP, 85%vs97%), limb salvage(LS, 93%vs100%), and overall survival(83% vs 89%) were not. Forty patients had OPEN, and 35 patients(23 ENDO, 12 HYBRID) had endovascular reconstructions. HYBRID group were sicker with worse preoperative functional status, more renal failure, and had more patients with CLI than ENDO and OPEN groups, and LOS were significantly less in ENDO than the other treatment groups(Table I). There was no perioperative mortality in any group, but overall morbidity was higher following open procedures. Preoperative ABI increased from 0.25+0.2 to 0.64+0.2 in OPEN and 0.26+0.2 to 0.76+0.2 after endovascular/hybrid procedures. 30-month PP was better after ENDO than HYBRID and OPEN, but APP, SP and LS was similar(Table II). Overall 30-month survival of HYBRID group was worse than ENDO.
Conclusions: Patients with complex aortoiliac occlusive disease are currently predominantly treated by endovascular procedures with improved PP and APP without significant differences in SP, LS and overall survival. Complex hybrid procedures has allowed treatment of sicker patients achieving similar results with open procedures with less morbidity.