Clinical Application Of Intracavitary Therapy In Subrenal Abdominal Aortic Occlusion

Section I:Endovascular Treatment for Infrarenal Aortic Occlusion:A Meta-AnalysisObjectives:Open surgery is a traditional treatment for infrarenal aortic occlusion(IAO).With the development of endovascular techniques,a number of articles on endovascular treatments(EVT)for IAO have been reported recently.Thus,the aim of this study was to synthesize data from recent literature to evaluate the safety and efficacy of endovascular treatments for IAO.Methods:The Pubmed and Embase were searched to identify all studies reporting EVT for IAO from January 1st,2000 to Dec 31st,2017.Studies were included if ?The article had no less than 10 patients with IAO receiving EVT;?The etiology of IAO was atherosclerosis;?Information of demography,comorbidities,technical success,mortality,complications,and follow-up was reported.We analyzed demography and comorbidities via weighted means and technical success,mortality,complications and follow-up patency via forest plots.Results:9 articles consisting of 220 patients were included in this meta-analysis.Mean age was 64.1 years with 72.1%male.Patients often had severe symptoms and many comorbidities.73.3%patients smoked.Ankle-brachial index(ABI)was 0.42 before endovascular treatments.The overall technical success and periprocedural mortality was 95.64%(95%confidence interval[CI]88.60%-99.42%),and 0.35%(95%CI 0.00%-2.33%).In the successful cases,ABI was raised from 0.42 to 0.91.Periprocedural complications included:vascular complications(12.78%(95%CI:5.82%-21.94%)),mainly pseudoaneurysm,thromboses,hematoma and dissections;renal complications 4.48%(95%CI 0.09%-8.87%);and limb complications 3.43%(95%CI:0.31%-6.54%).Overall primary patency was 93.53%(95%CI:89.37%-97.68%)at 1 year,78.96%(95%CI:72.26%-84.96%)at 3 year and 75.31%(95%CI:66.42%-84.20%)at 5 year.Overall secondary patency was 98.25%(95%CI:95.50%-99.73%)at 1 year,95.92%(95%CI:89.25%-99.47%)at 3 year and 94.02%(95%CI:88.10%-98.00%)at 5 year.Conclusions:EVT for IAO is acceptable with relatively high technical success rate,low mortality,and satisfying short-term patency.Although primary patency was lower than that after surgery,secondary patency was robust.However,this conclusion was based on retrospective observational studies,and the results could be imprecise due to limited sample size,especially in mid-and long-term patency.More studies with longer follow-up and bigger sample size,are needed to further elucidate this.Section II:Endovascular Treatment for Infrarenal aortic occlusion:a single-center experienceObjectives:Infrarenal aortic occlusion(IAO)was defined as total occlusion of aorta below the renal arteries.Traditional treatments included anatomic bypass and extra-anatomic bypass.With the developments of techniques,endovascular treatments(EVT)were emerging.Thus,the aim of this part was to compare the safety and efficacy among anatomic bypass,extra-anatomic bypass and EVT.Methods:The retrospective study included patients with atherosclerosis-induced chronic IAO who were admitted at Peking Union Medical College Hospital between January 1st,2003 to Dec 31st,2017.We analyzed these patients,demography,comorbidities,technical success,mortality,complications,and follow-up.Results:A total of 55 patients were included,51 of whom were male.The mean age was 59.7 years.Approximately 90%of all patients were heavy smoker.The commonest comorbidities was hypertension.According to their initial treatments,16 patients were in EVT group with 28 in anatomic bypass group and 11 in extra-anatomic bypass group.The age and Rutherford classification of patients in extra-anatomic bypass group were significantly higher the other 2 groups(P<0.05).The post-procedure hospital stays(median)were 4 days in EVT group and significantly shorter than the other 2 groups,both of which were 11 days(P<0.05).As for technical success,comorbidities,mortality,complications and Rutherford classification after procedures,no difference was observed(P>0.05).As for long term results of patients who reached asymptomatic after procedure,1-year,3-year and 5-year the cumulative event-free survival rates were 91.1%,91.1%and 91.1%in EVT group,100%,83.6%and 70.7%in anatomic bypass group,80.0%,20.0%and 20.0%in extra-anatomic bypass group.No difference was observed between EVT and anatomic bypass(P>0.05),but the follow-up of extra-anatomic group was significantly worse(P<0.05).Conclusions:Safety and efficacy were similar between EVT and anatomic bypass among normal risk patients.Patients in extra-anatomic group were older and had worse Rutherford classification,whose long-term patency was also unsatisfactory.EVT might be one of feasible options for IAO.