Abstract No. 209: Single center outcomes of selective percutaneous endografting

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   Purpose:  To report the immediate and long-term results of cryoplasty versus conventional balloon angioplasty in thefemoropopliteal artery of diabetic patients.  Materials and Methods:  The study was approved by theHospital’s Scientific Committee and all patients signed aninformed consent. 50 diabetic patients (41 males, mean age68 years) were randomized to undergo either PolarCathCryoplasty (Group CRYO; 24 patients with 31 lesions)or conventional balloon angioplasty (Group COBA; 26patients with 34 lesions) of the femoropopliteal artery.Technical success was defined as   30% residual stenosiswithout any adjunctive stenting. Regular clinical and angio-graphic follow-up was scheduled at 6 months, 1 year andannually thereafter. Primary clinical endpoints were patientsurvival, limb salvage and repeat intervention events of thetreated artery. Primary angiographic endpoints included pri-mary patency and angiographic binary restenosis (  50%)of the treated lesion. Multivariable Cox model analysis(stepwise backwards logistic regression) was performed toadjust for confounding factors of heterogeneity.  Results:  Angioplasty technical success rate was 58% ingroup CRYO vs. 64% in group COBA (p  ns). Overallfollow-up period was similar in both groups (32  9 and32  2 months, respectively). After 3 years, there were nosignificant differences with regard to patient survival(86.8% in group CRYO vs. 87.0% in group COBA) andlimb salvage (95.8% vs. 92.1% in groups CRYO andCOBA, respectively). Angiographic binary restenosis wassimilar between the 2 groups (HR: 1.31, 95%CI: 0.66-2.61,p  0.45). Primary patency was significantly lower in groupCRYO versus group COBA (HR: 2.20, 95%CI: 1.12-4.31,p  0.02). Significantly more repeat intervention events be-cause of recurrent symptoms were observed in group CRYO(HR: 2.49, 95%CI: 1.16-5.31, p  0.02). Conclusion:  Compared to conventional balloon angio-plasty, cryoplasty of the femoropopliteal artery in diabeticpatients was associated lower primary patency and moreclinically driven repeat procedures after long-term follow-up. 4:12 PM Abstract No. 208Single center experience with drug eluting stents forinfrapopliteal occlusive disease in patients with criticallimb ischemia A.M. Fischman, S.S. Shah, E. Kim, P. Stangl,F. Nowakowski, J.L. Weintraub, R. Lookstein;  Mount Sinai Medical Center, New York, NY.  Purpose:  Drug-eluting stents (DES) have been shown to beeffective in the treatment of coronary artery disease. Thisstudy reports a single center experience in the use of thistechnology in the treatment of infrapopliteal occlusive dis-ease in the setting of critical limb ischemia.  Materials and Methods:  From October 2005 to September2009, 53 patients (32 male, 21 female)(mean age 82, range43-93) underwent implantation of drug eluting stents to treata suboptimal angioplasty result in an infrapopliteal artery.All patients had symptoms of critical limb ischemia withRutherford grade 4 (n  15), 5 (n  29) or 6 (n  9) disease atpresentation prior to treatment. Angiographic, clinical andnoninvasive vascular examination results were collectedprospectively at regular intervals. Primary endpoints in-cluded technical success of the revascularization procedure,primary patency, freedom from major amputation and sur-vival at follow up.  Results:  94 infrapopliteal drug eluting stents (80 siroli-mus, 12 evirolimus, 2 paclitaxel) were placed in 53patients (32 men, 21 women, mean age 82, range 43-93)to treat 60 angiographic lesions. Initial technical successrate was 100% with all treated lesions having less than10% residual angiographic stenosis at completion of theprocedure. The mean number of stents placed per patientwas 1.62 (range 1-5). Stent diameter ranged from 2.5mmto 4mm. 35/53 (66%) underwent simultaneous femoral-popliteal intervention. 21/60 (35%) lesions treated weretotal occlusions. Mean follow up was 17 months (1-42months). Primary patency at 12 months was 45/55(80%). Freedom from major amputation at followup was90.6% (48/53) for the entire cohort, 100% (44/44) forpatients with Rutherford category 4 and 5 disease. 30 daymortality rate was 1.9% (1/53). Overall mortality ratewas 22.6% (12/53). Complete follow up data will bepresented at the meeting. Conclusion:  Placement of infrapopliteal drug eluting stentsis safe and effective therapy following suboptimal angio-plasty in patients with critical limb ischemia. This procedurehas excellent technical success and demonstrates high pri-mary patency and limb salvage rates. 4:24 PM Abstract No. 209Single center outcomes of selective percutaneous en-dografting L. Garcia  1 , B. Arslan  2,3  , U.C. Turba  2  , S. Sabri  2  ,E.A. Ahmad  2  , J.F. Angle  2  , J.D. Adams  2  , K. Hagspiel  2  ; 1 Surgery, University of Virginia, Charlottesville, VA;  2  Ra-diology, University of Virginia, Charlottesville, VA;  3  Moffitt Cancer Center and Research Institute, Tampa, FL.  Purpose:  To evaluate the safety and efficacy of selectivepercutaneous percutaneous endografting in a large singleuniversity institution.  Materials and Methods:  A retrospective review of allpercutaneous TEVAR and EVAR cases from July 2006until October 2008 was performed. There were 72 pa-tients that underwent endografting with percutaneous clo-sure of their arteriotomies using the Proglide arterialclosure device during this time period. A previouslydescribed “pre-closure” technique utilizing two closuredevices was used in all of these cases. Although this wasnot a prospective study, in all cases pre-procedure CTAfindings of the common femoral arteries were reviewedas a practice pattern in our institution. Severe anteriorwall calcifications, small femoral artery diameter, andsevere surgical scarring were considered as contraindica-tions for percutaneous closure. Only patients who hadavailable CT Angiogram studies prior to and after en-dografting were included in the study. Patients wereevaluated for hematoma, pseudoaneurysm formation, anddegree of stenosis at the access site in comparison topre-procedure imaging. Degree of stenosis was groupedinto four catergories: 1) less than 10% 2)   10% but  50% 3)   50% 4) occluded. All CTAs were reviewedby a board certified radiologist at our institution to elim-inate bias.  Results:  A total of 50 patients had adequate follow upimaging to be included in this study. There were 77 com-mon femoral arteriotomies that were closed with the pro-glide devices. Sheath sizes ranged from 18 French to 25French. The average follow up time was 6 months. Weachieved hemostasis in all femoral arteries that were closedpercutaneously. There were no early or late bleeding com- S80  plications. There was one late pseudoaneurysm formation(1.29%). There was no evidence for stenosis related toclosure. Conclusion:  Selective percutaneous approach is a safe andeffective alternative to surgical cut-down for endograftingprocedures. Our retrospective review suggests excellent out-comes when patients are carefully selected using preopera-tive CT scans. However randomized prospective studies arenecessary to confirm this conclusion. 4:36 PM Abstract No. 210Use of iliac branch grafts in the treatment of aorto-iliacaneurysms, a single institution experience U. Pua  1,2  , K. Tan  1 , T. Lindsay  3  , D.K. Rajan  1 ,G. Oreopoulos  3  ;  1 University Health Network and Mount Sinai Hospital, Toronto University, Toronto, ON, Canada; 2 Tan Tock Seng Hospital, Singapore, Singapore;  3 TorontoGeneral Hospital, Toronto, ON, Canada.  Purpose:  To evaluate the feasibility and efficacy of iliacbranch graft (IBG) in endovascular repair of aorto-iliacaneurysms.  Materials and Methods:  From July 2007 to August 2009,11 men (mean age 70.1 years, range 59.3-80.0 years) weretreated with iliac branch graft (IBG). Indications were ab-dominal aneurysm with common iliac artery (CIA) involve-ment (n  9), thoracoabdominal aneurysm with CIA in-volvement (n  1), and bilateral internal iliac arteryaneurysm (n  1). Post-operative endoleaks and patency ratewere determined with CT (n  9) and contrast enhancedultrasound (n  1) at 3 months and 1 year, with concurrentclinical follow-up for symptoms of pelvic ischemia. Aver-age follow-up period was 20.5 months (range 5 - 27months).  Results:  Technical success defined by successful implan-tation of endograft was 91% (10/11). The single case of technical failure was due to straightening of the CIA byguidewire, resulting in kinking of the IIA. A total of 11IBGs were successfully deployed in 10 patients. Themean diameters of the abdominal aorta and CIA aneu-rysms were 6.0 cm (range 3.4 - 8.7 cm) and 3.9 cm (range3.4 - 5.7 cm). 5 patients had embolization of the con-tralateral IIA (3 pre-operative, 2 intra-operative), and in4 patients the contralateral IIA were left intact. 1 patienthad a pre-existing aorto-femoral bypass on the contralat-eral CIA. No intra-operative branch loss was recorded.Mean hospitalization duration was 6.5 days (range 3-14days). Thirty-day complications include bilateral lym-phatic leak from femoral cut down (n  1), recurrent hy-potension requiring prolonged intubation (n  1), andpost-operative psoas abscess (n  1), that resulted in apersistent discharging sinus after percutaneous drainage.Thirty-day mortality rate was zero. There were two casesof type 2 endoleak from lumbar branch into the aorticaneurysms that were treated conservatively. No increasein size in the treated aortic and iliac aneurysms wasfound, and all stented IIA branches remained patent.None of the treated patients have symptoms of pelvicischemia at the end of the study period. Conclusion:  IBG is a feasible option and presents an op-portunity for preservation of pelvic perfusion in the treat-ment of aorto-iliac aneurysms. 4:48 PM Abstract No. 211Fenestrated and branched endovascular aortic repair inthe treatment of complex aortic aneurysms, a singleinstitution experience U. Pua  1,2  , K. Tan  1 , T. Lindsay  3  , D.K. Rajan  1 ,G. Oreopoulos  3  ;  1 University Health Network and Mount Sinai Hospital, Toronto University, Toronto, ON, Canada; 2 Tan Tock Seng Hospital, Singapore, Singapore;  3 TorontoGeneral Hospital, Toronto, ON, Canada.  Purpose:  To present our single-center experience in the useof fenestrated and branched endografts in complex aorticaneurysms.  Materials and Methods:  From November 2007 to August2009, 16 patients (15 men, mean age of 71.6 years (range59.9 - 87.7 years)), were treated with advanced endovascu-lar aortic repair (EVAR). A total of 50 fenestrated/branchedprocedures (30 fenestrations, 15 side branches and 5 scal-lops) were performed on 12 juxta-renal aneurysms and 4thoraco-abdominal aneurysms. All had unsuitable anatomyfor conventional EVAR and were at high risk for opensurgery. The mean aortic aneurysm diameter treated was 6.6cm (range 5.2 - 9.0 cm). Patients were reviewed clinicallyand with CT at 3 months and yearly interval.  Results:  Technical success in primary cannulation/stentingof target visceral branches was 96% (48/50). There was asingle intraoperative branch loss (2%) due to inability toalign a celiac axis with the branch. Open surgical arterialaccess and retrograde endovascular stenting was required tosalvage a failed renal artery cannulation of fenestration(2%).). Thirty days complication include myocardial infarc-tion (n  1), paralytic ileus (n  1), bleeding from spinaldrain (n  1), bilateral deep vein thrombosis (n  1) andhematoma from axillary puncture (n  1), all were treatedconservatively. The mean length of stay was 8.2 days (range3 - 21 days) and 30-day mortality rate was zero. All suc-cessfully cannulated visceral vessels remained patent on CTfollow-up (100%). There was no case of rupture or aneu-rysm sac size increase of    5mm recorded in any of thepatients. There were 3 cases of type 2 endoleak (2 frominferior mesenteric artery, 1 from intercostals artery), allhad stable sac size and remained under surveillance. Therewere 3 cases of junctional leak (type 3 endoleak), of whichtwo renal artery junctional leak were treated with overlapstenting (one resolved, one persistent), and in one case bothright renal and superior mesenteric artery branches junc-tional leak showed spontaneous partial resolution on follow-up. Conclusion:  In selected patients, advanced EVAR appear tobe safe with good technical success and acceptable compli-cation rates. Endoleak is the most common complication. 5:00 PM Abstract No. 212Endovascular repair of popliteal artery aneurysms withGORE VIABAHN stent-graft: Early results H.C. Le  1,2  , T.D. Reil  1,3  , S.M. Santilli  1,3  , J.W. Myers  1,4  , J.T. Wong  1,5  , J. Golzarian  1,5  ;  1  Minneapolis Veterans Af- fairs Medical Center, Minneapolis, MN;  2  Medical School,University of Minnesota, Minneapolis, MN;  3  Department of Surgery—Vascular Surgery, University of Minnesota, Min-neapolis, MN;  4  Institute of Technology, University of Min-nesota, Minneapolis, MN;  5  Department of Diagnostic Ra-diology—Interventional Radiology, University of  Minnesota, Minneapolis, MN.  S  ci    en t  i   fi  c S  e s si    on sWE DNE  S DA Y  S81
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