Management of Advanced Aortoiliac Occlusive Disease with the Gore Iliac Branch Endoprosthesis

Objective Aortoiliac occlusive disease (AIOD) is a common late manifestation of peripheral vascular disease. The TransAtlantic Inter-Society Consensus guidelines have established aortobifemoral bypass as the “gold standard” for advanced lesions, with 10-year patency rates upward of 90%, but open surgery carries significant morbidity and mortality. Endovascular techniques have begun to challenge the open paradigm, especially in high-risk surgical candidates. We present our experience using the Gore Iliac Branch Endoprosthesis (IBE; W. L. Gore & Associates, Flagstaff, Ariz) in the treatment of advanced AIOD. Methods We performed a retrospective chart review of 18 patients with TransAtlantic Inter-Society Consensus type C and D lesions undergoing endovascular treatment with IBE for AIOD. Results Eighteen patients (36 limbs) were analyzed. Patients had an average age of 63.6 years, with an average American Society of Anesthesiologists score of 3.33. The average length of stay was 5.6 days. Six cases were emergent and done for aortic or iliac occlusion. Successful endovascular recannulization was achieved in 100% of limbs, with 44% requiring concurrent femoral endarterectomy. Thirty-two limbs have been seen in follow-up with an average primary patency of 78% (25/32) and primary assisted patency of 87.5% (28/32) at an average of 4.5 months (range, 1-20 months). Four limbs (4/32 [12.5%]) have required an aortobifemoral bypass, with secondary patency of 100%. Procedure-related complications were seen in three patients (two groin infections and one patient with acute-on-chronic renal failure). Procedure-related mortality was seen in one patient who died of aspiration pneumonia. Conclusions The IBE offers an endovascular solution to advanced AIOD, with precannulation of the contralateral gate providing a technical advantage to other endovascular solutions. An endovascular first option with the IBE offers promising primary patency rates and does not preclude future open solutions. Long-term follow-up is needed to document IBE durability in AIOD