Covered endovascular reconstruction of aortic bifurcation, early and mid-term outcomes: A retrospective study

Introduction: Atherosclerotic peripheral vascular disease is a leading cause of limb loss with a subsequent disability, inflow problem can be managed by different surgical and endovascular methods with variable outcomes, the extent of the lesion, and resource availability might affect the surgeon's decision regarding modality selection for treatment. Aim: To evaluate the feasibility and effectiveness of covered stent graft in patient with inflow problems as rather new modality of treatment with mid-term follow-up. Patients and Methods: The single center retrospective study included all patients treated with covered endovascular reconstruction of aortic bifurcation in the period from February 2018 to February 2022 with Trans-Atlantic Inter-Society Consensus (TASC) C and D treated with this modality and follow-up of 18 months was rolled in. Results: A total of 23 patients, 18 male and five females average age 63.7 +/- 7 years, type II diabetes in 91%, hypertension 78%, dyslipidemia 69%, COPD 22%, and smoking 13%, presenting symptom was incapacitation claudication in 56% and critical limb ischemia in 44%, preoperative imaging showed aorto-iliac disease TASC C in 39% while TASC D in 61%, technical success in 100%, no immediate intraoperative complication, primary patency rate was 87% at 24 months, secondary patency rate was 95%. Two (9%) patients underwent re-intervention for unilateral external iliac occlusion and common femoral tight stenosis with decreasing walking distance and another one patient with unilateral occluded iliac stent managed conservatively. Conclusion: Covered endovascular reconstruction of aortic bifurcation in selective patient's population gives good results with a low rate of complications and need for re-interventions, the high cost of this modality will be always a limiting factor despite of expected superiority over the permetal stents, larger multi-center randomized controlled studies are needed for better evaluation of this technique competed to surgical reconstruction and other endovascular techniques.