Fazzini, Stefano; Pennetta, Federico Francisco; Torsello, Giovanni; Turriziani, Valerio; Vona, Simona; Ascoli Marchetti, Andrea; Ippoliti, Arnaldo; Austermann, Martin; Bosiers, Michel Joseph (2024). Intravascular Iliac Artery Lithotripsy to Facilitate Aortic Endograft Delivery: Midterm Results of a Dual-Center Experience. (In Press). Journal of endovascular therapy(15266028241241246), p. 15266028241241246. Sage 10.1177/15266028241241246
Full text not available from this repository. (Request a copy)PURPOSE
To assess the feasibility and safety of intravascular lithotripsy (IVL) for enabling transfemoral abdominal (EVAR), thoracic (TEVAR), and thoracoabdominal (BEVAR) endovascular aneurysm repair in patients with narrow and calcified iliac arteries.
MATERIALS AND METHODS
Consecutive patients treated with IVL for severe calcified and narrowed iliac access before EVAR, TEVAR, or BEVAR between November 2020 and June 2022 were retrospectively evaluated. All anatomical iliac characteristics were acquired by multi-planar reconstruction of preoperative computed tomography angiography (CTA). The hostility of the vascular accesses was classified based on Peripheral Arterial Calcium Scoring System (PACSS) and calcified access severity score (CASS), a new score considering both anatomical (calcium grade and length, minimum lumen diameter [MLD], and tortuosity index) and aortic stent-graft (SG/MLD index) parameters. Primary endpoint was technical success defined as successful aortic endograft delivery and deployment without iliac rupture. Freedom from complications and primary patency were additionally analyzed.
RESULTS
Twenty-eight iliac axes were treated with IVL (8 bilateral) in 20 patients (mean age 74.5±6.7 years) with a mean follow-up of 26.5±6.2 (range 17-36) months. Ten patients underwent EVAR: 3 TEVAR, and 7 BEVAR procedures. In 14 patients (70%), aneurysm disease was associated with symptomatic aorto-iliac occlusive disease (AIOD), with Rutherford class III to IV. The PACSS was grade IV in 89% of the cases and the CASS (mean 14±2) was grade III to IV in all cases. The stent-graft (SG) outer diameter (5.60±1.65 mm) was significantly larger by 50% than MLD (3.96±1.20 mm), with an SG/MLD index of 1.50±0.51 (p<0.001). Technical success was 100%. No dissection, rupture, or distal embolization occurred. One (3.4%) bail-out stenting was necessary as endoconduit after IVL treatment. One month CTA showed that postoperative luminal gain increased by 93% (p<0.001). An improvement of 2 Rutherford classes occurred in all AIOD patients with a primary patency of 100% at last follow-up.
CONCLUSIONS
This study shows the safety and feasibility of IVL as a valuable option to treat narrow and calcified iliac arteries to facilitate endograft delivery. Further studies will be useful to confirm these results.
CLINICAL IMPACT
In this article, the use of intravascular iliac artery lithotripsy to facilitate aortic endograft delivery is explored. The presence of iliac severe calcifications still represents a contraindication for aortic endovascular repair. Intravascular lithotripsy increases the feasibility and safety of endovascular aortic procedures, facilitating endograft delivery and reducing the risk of iliac rupture and/or dissections by improving vessel compliance and luminal gain. This novel vessel preparation could be an alternative to "paving and cracking" and/or iliac conduits. This study describes a new score to classify the severity of iliac calcifications, considering anatomical parameters and the profile of aortic endografts delivery system.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Vascular Surgery |
UniBE Contributor: |
Bosiers, Michel Joseph Robert |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1545-1550 |
Publisher: |
Sage |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
02 Apr 2024 15:38 |
Last Modified: |
03 Apr 2024 00:17 |
Publisher DOI: |
10.1177/15266028241241246 |
PubMed ID: |
38561973 |
Uncontrolled Keywords: |
abdominal endovascular aortic repair aorto-iliac occlusive disease calcified iliac hostile access iliac conduit intravascular lithotripsy large-bore devices paving and cracking thoracic endovascular aortic repair vessel compliance |
URI: |
https://boris.unibe.ch/id/eprint/195546 |
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