O-026 - ENDOVASCULAR THERAPY AS AN ALTERNATIVE TO BYPASS SURGERY FOR JUXTARENAL AORTIC OCCLUSION: SUBGROUP ANALYSIS OF CHAOS (CHRONIC ABDOMINAL AORTIC OCCLUSION, ASIAN MULTICENTER) REGISTRY.

TOPIC:
Peripheral Occlusive Arterial Disease
AUTHORS:
Banno H. (Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine ~ Nagoya ~ Japan) , Fujimura N. (Department of Vascular Surgery, Saiseikai Central Hospital ~ Tokyo ~ Japan) , Obara H. (Department of Surgery, Keio University School of Medicine ~ Tokyo ~ Japan) , Ichihashi S. (Department of Radiology, Nara Medical University ~ Nara ~ Japan) , Kudo T. (Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University ~ Tokyo ~ Japan) , Hozawa K. (Department of Cardiovascular Medicine, New Tokyo Hospital ~ Chiba ~ Japan) , Yamaoka T. (Department of Vascular Surgery, Matsuyama Red Cross Hospital ~ Ehime ~ Japan) , Kian C.N.J. (Department of Vascular Surgery, Singapore General Hospital ~ Outram ~ Singapore) , Tan J.W. (Department of Cardiovascular Surgery, An Nan Hospital, China Medical University ~ Tainan ~ Taiwan) , Park K. (Division of Vascular Surgery, Department of Surgery, Daegu Catholic University School of Medicine ~ Daegu ~ Korea, Republic of) , Skyi P.Y. (Department of Surgery, Pamela Youde Nethersole Eastern Hospital ~ Chai Wan ~ Hong Kong) , Kato T. (Department of Cardiology, Rakuwakai Otowa Hospita ~ Kyoto ~ Japan) , Kawarada O. (Department of Cardiovascular Medicine, Hanwa Memorial Hospital ~ Osaka ~ Japan) , Komori K. (Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine ~ Nagoya ~ Japan)
Introduction:
Even in this endovascular era, juxtarenal aortic occlusion (JRAO), in which the occlusion of the aorta extends to just below the renal artery, is still often treated by bypass surgery since there are concerns about not only procedural failure but also the risk of fatal embolization of abdominal organs. The purpose of this study was to assess the outcome of endovascular treatment (EVT) for JRAO by comparing it with those of aorto-bifemoral (AOB) or axillo-bifemoral (AXB) bypass.
Methods:
A retrospective review of an international database created by 30 centers in Asia (CHAOS [Chronic Abdominal Aortic Occlusion, Asian Multicenter] registry) was performed for patients who had undergone revascularization for chronic toral occlusion (CTO) of the infrarenal aorta from 2007 to 2017. Of the 436 patients, 130 who presented JRAO were included in this subgroup analysis. Patient demographics, preoperative lesion characteristics, perioperative results, and long-term outcomes were collected.
Results:
orty-seven AOBs, 32 AXBs, and 51 EVTs were extracted. Patients were significantly older in the AXB and EVT groups and more malnourished in the EVT group than in the AOB group. Patients who presented chronic limb-threatening ischemia (CLTI) were more common in the AXB and EVT groups. The procedure time was significantly longer in the AOB group, and the duration of hospital stay was shorter in the EVT group than in the other two groups. EVT was attempted but failed in one patient. Periprocedural adverse events occurred in 5 (10.6%) patients in the AOB group, 7 (21.9%) patients in the AXB group, and 11 (21.6%) patients in the EVT group (N.S.). Six patients (1 [2.1%] in the AOB group, 1 [3.1%] in the AXB group, and 5 [9.8%] in the EVT group) died during their hospital stays (N.S.). At the latest follow-up, the ankle-brachial pressure index was significantly higher, in the order of AOB, EVT, and AXB. Among the CLTI patients, all AOB patients recovered to Rutherford class 0, but three patients in the AXB group and 4 in the EVT group retained CLTI. Both the estimated primary and secondary patency rates of the AOB group were significantly higher than those of the AXB group.
Conclusion:
The results from the present study suggest that EVT for JRAO can be a sufficient alternative to open surgical bypass. Despite the long lesion and the proximity of the occlusion to the visceral branches, EVT for JRAO was relatively safe and achieved both an excellent success rate and good long-term patency.