Endologix Unibody Endograft performance in Aortoiliac occlusive disease
The field of endograft manufacture and design has been an active one with improved performance and lower profile devices under continuous development. A multicenter retrospective review was conducted to evaluate safety, efficacy and early patency rates of the 17Fr ipsilateral, 9Fr contralateral Endologix AFX unibody endograft in the treatment of aortoiliac occlusive disease and recently published in the European Journal of Vascular and Endovascular Surgery.
91 patients were treated for aortoiliac occlusive disease. Patients with concomitant aortic aneurysm were excluded. Mean follow up was 22.2 months. Technical success was 100%. Complication rate was 22% with 1 mortality in the 30 day follow up period from extensive pelvic thromboembolism. At 1 year 73% of patients experienced improvement in Rutherford stage of -3 or greater compared with baseline. At all points primary patency were >90%, assisted patency rates were >98% and secondary patency rates were 100%.
Use of the AFX unibody stent-graft had a high rate of technical success and a low morality rate. Patency rates were comparable to with open aortobifemoral bypass, kissing stent and CERAB techniques. This study is the largest so far in the evaluation of the AFX unibody graft performance. Notably 82% of patients treated in this study had baseline TASC D disease making the already favorable patency data arguably even more so. 41% of these cases were done percutaneously with hemostasis achieved using the Proglide (Abbott Vascular, Abbott Park, IL, USA). Although the authors indicate that the use of re-entry devices was not necessary, they say these may be helpful to obtain femoral-femoral wire access in some cases. It is not clear what proportion of aortoiliac lesions were successfully crossed in an intraluminal position and which if any required subintimal angioplasty (SIA). Furthermore if there were lesions which required SIA it is unclear if these were included.
Although the complication rate was high (22%) none of the complications appear to be device related. The majority of the complications appear to be related to the open femoral access utilized in 59% of cases. The incidence of groin related complications in this study is comparable with that found in open surgical repair and may reflect that this subset of patients is exposed to the same risks found in open surgery. Overall, this manuscript serves as continued support in using the Endologix device in cases of aortoiliac occlusive disease in which the cranial extent of occlusion makes kissing stents unfavorable.
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Maldonado TS, Westin GG, Jazaeri O, et al. Treatment of aortoiliac occlusive disease with the Endologix AFX unibody endograft. Eur J Vasc Endovasc Surg. May 2016. doi: 10.1016/j.ejvs.2016.04.003
Marco Ugas, MD
University of Virginia
PGY-5 Radiology Resident