Aortoiliac Lesions
In recent years, advances in endovascular treatment methods have led to an improvement in primary and secondary patency rates even for complex TASC C and D lesions.
A systematic review of 19 cohort studies with 1711 patients indicates that after endovascular treatment of complex aortoiliac lesions (TASC II C and D), the primary long-term patency rate (5-7 years) was indeed lower than after open bypass procedures, but the secondary patency rate (4-5 years) was comparable [1]. Taking into account the heterogeneity of the studied populations and used endovascular techniques, the technical success rate was between 86 – 100 %, the clinical improvement at 83 – 100 % and the mortality rate between 1.2 – 6.7%. Furthermore, the review shows a higher primary patency rate after primary stent angioplasty than after primary balloon angioplasty. This is also the result of a meta-analysis of 16 retrospective studies on a total of 958 patients with TASC C and D lesions [2].
A prospective, non-randomized study published in 2013 from Belgium and Italy supports the high technical success rates as well as the independence of patency rates from the complexity level (TASC II A-D) of the lesions [3]. Thus, the 12-month patency rates after endovascular procedure for TASC A-B-C and D lesions were 94.0 % - 96.5 % - 91.3 % and 90.2 %.
The endovascular treatment of aortoiliac lesions does not appear to lead to an impairment of subsequent open therapies, as shown by a retrospective cohort study from 2012 [4]. After failed endovascular treatment of aortoiliac lesions over a period of up to 3 years, there were no worse outcomes in the subsequently performed open surgical therapy compared to primary open surgical therapy.