Primary balloon expandable polytetrafluoroethylene-covered stenting of focal infrarenal aortic occlusive disease

Background: Focal infrarenal aortic occlusive disease requiring treatment is an uncommon condition. Short lesions may be treated endovascularly, while long lesions are traditionally treated by surgery. Advances in endovascular devices, including development of covered stents, may expand endovascular options. This study evaluates the feasibility, safety, and midterm results of primary polytetrafluoroethylene (PTFE)-covered stenting of isolated atherosclerotic lesions of the infrarenal aorta. Material and Methods: Between November 2008 and March 2011, 12 patients, aged 59 (42 to 78) years, were treated with a balloon-expandable PTFE-covered stent for a focal infrarenal aortic stenosis (n = 11) or occlusion (n = 1). Indications included disabling claudication (n = 9), rest pain (n = 1), or minor tissue loss (n = 2) Follow-up consisted of clinical examination, ankle-brachial indexes, plain abdominal radiography and duplex ultrasonography. Results: Eleven procedures were performed percutaneously and one in combination with an endarterectomy of the right common femoral artery. Technical success was 100%, and clinical improvement was achieved in all but one patient, who needed additional femoropopliteal bypass surgery. The median follow-up was 18 months (range 2-30 months). During follow-up, all patients remained asymptomatic and ankle-brachial indexes had normalized. Duplex ultrasonography showed no re-stenosis, and there were no stent fractures on abdominal radiographs. Conclusions: The primary use of PTFE-covered stents is a feasible, effective, and safe treatment for focal atherosclerotic lesions in the infrarenal aorta. Comparative studies with traditional treatment modalities, however, are indicated before considering the use of covered stents as standard treatment.