Optimizing Endovascular Treatment of Lower Extremity Arterial Occlusive Disease

Lower extremity peripheral arterial disease (PAD) is the third leading cause of atherosclerotic vascular morbidity (after coronary heart disease and stroke) and is associated with significant morbidity, mortality and quality of life impairment. Symptoms vary from reduced walking distance, to rest pain and tis sue gangrene due to impaired blood flow to the extremities. Selecting the best treatment modality for patients with symptomatic PAD is determined by patient factors such as age, severity of disease and comorbidities, as well as lesion characteristics, such as location, lesion length and calcification. Bypass surgery and endarterectomy provide excellent long-term patency rates, however these are obtained at the price of high morbidity and mortality rates. Endovascular treatment has good safety and short-term efficacy with decreased morbidity, complications and costs compared with open surgical procedures. However long time durability is dissapointing. In the frail and aging vascular patients, endovascular treatment gains popularity because of its minimally invasive character, with increasing durability. Improved outcomes after endovascular treatment of PAD are the result of technical innovations as well as optimized treatment strategies. This thesis aims to provide insight in these recent treatment strategies and the use of new devices. Treatments and outcomes of importance differ between the different vascular territories, therefore this thesis is divided in different parts and covers; Stent placement in endovascular treatment of iliac artery occlusive disease; Endovascular treatment of femoropopliteal artery occlusive disease; Endovascular treatment of autologous bypass grafts; Angiosome concept theory

Self-expanding stents and aortoiliac occlusive disease: A review of the literature

The treatment of symptomatic aortoiliac occlusive disease has shifted from open to endovascular repair. Both short- and long-term outcomes after percutaneous angioplasty and stenting rival those after open repair and justify an endovascular-first approach. In this article, we review the current endovascular treatment strategies in patients with aortoiliac occlusive disease, indications for primary and selective stenting in the iliac artery, and physical properties and future perspectives of self-expanding stents

Endovascular treatment of common iliac artery aneurysms with an iliac branch device: Multicenter experience of 140 patients

Purpose: To evaluate the efficacy, feasibility, and long-term outcomes of the Zenith ZBIS iliac branch device (IBD) to preserve internal iliac artery (IIA) perfusion in a large Dutch multicenter cohort. Methods: Between September 2004 and August 2015, 140 patients (mean age 70.9±7.4 years; 130 men) with 162 IBD implantations were identified in 7 vascular centers. The indication for IBD implantation was an abdominal aortic aneurysm <55 mm with a concomitant common iliac artery (CIA) aneurysm <20 mm (n=40), a CIA aneurysm with a diameter <30 mm (n=89), or revision of a type Ib endoleak after endovascular aneurysm repair (n=11). Results: Technical success (aneurysm exclusion, no type I or III endoleak, and a patent IIA) was obtained in 157 (96.9%) of 162 IBD implantations. Six (4.3%) patients developed major complications; 2 (1.4%) died. Mean follow-up was 26.6±24.1 months, during which 17 (12.1%) IBD-associated secondary interventions were performed. Including technical failures and intentional IIA embolizations, 15 (9.3%) IIA branch occlusions were identified; buttock claudication developed in 6 of these patients. The freedom from secondary intervention estimate was 75.9% (95% confidence interval 59.7 to 86.3) at 5 years. Conclusion: CIA aneurysms can be treated safely and effectively by IBDs with preservation of antegrade flow to the IIA. Secondary interventions are indicated in <10% of patients during follow-up but can be performed endovascularly in most