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Vascular: Primary Stenting Effective for Focal Aortic Lesions

Eighty-five percent of patients were able to walk an unlimited distance after treatment

Endovascular treatment with bare metal stents should be the first-line treatment for focal occlusive aortic disease, according to a recent study in the Journal of Vascular Surgery.

Angioplasty and stenting have become popular alternatives to a surgical approach for occlusive disease. Little data existed regarding which procedure was optimal for focal aortic stenosis and occlusion, however. The authors of the current study thus sought to investigate early and late outcomes with primary stenting. They conducted a retrospective analysis of 52 patients undergoing endovascular treatment for occlusive arterial disease with atherosclerotic lesions localized at the infrarenal abdominal aorta. Each patient had stenosis greater than 60 percent (determined via angiograms) with a pressure gradient through the lesion greater than 15 mm Hg, and was treated between February 2002 and November 2009. Forty-three patients were treated for severe claudication, five for ischemic rest pain, and four for minor tissue loss. Follow-up occurred at three, six, and 12 months post-procedure, and annually thereafter. Mean follow-up time was 39.4 months.

The authors reviewed all patient characteristics, comorbidities, operative data, and postoperative complications. Hemodynamic success was achieved in all cases, and clinical improvement in 96 percent. Every participant also had an improved ankle brachial index. Nine patients had symptom recurrence and 11 reinterventions were performed during the follow-up period. Eighty-five percent of the patients were able to walk an unlimited distance during follow up. The estimated assisted primary patency at nine years was 96 percent; mean survival time was almost 87 months. ”Primary stenting [with bare metal stents] offers safe and durable results and should be considered as the first line of treatment for focal aortic lesions,“ the authors write.

Source: Schwindt AG, Panuccio G, Donas KP, et al. 2011. Endovascular treatment as first line approach for infrarenal aortic occlusive disease. Journal of Vascular Surgery 53: 1550-1556.