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 subsequent disability, inflow problem can be managed by different surgical and endovascular methods with variable outcomes, extent of the lesion and resources availability might affect the surgeon decision regarding modality selection for treatment.Aim of the work: 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. Patient and methods: Single center retrospective study included all patients treated with covered endovascular reconstruction of aortic bifurcation in period from February 2018 to February 2022 with TASC C&D treated with this modality and followed up of 18 months were rolled in. Results: 23 patients,18 male and 5 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%, pre-operative imaging showed aorto-iliac disease TASC C in 39% while TASC D in 61%, technical success in 100%, no immediate intra-operative complication, primary patency rate was 87%% at 24 months, secondary patency rate was 95%. 9% (2 patients) underwent re-intervention for unilateral external iliac occlusion and common femoral tight stenosis with decreasing walking distance and another 1 patient with unilateral occluded iliac stent managed conservatively.Conclusion: Covered Endovascular Reconstruction of Aortic Bifurcation in selective patient’s population gives good results with low rate of complications & need for re-interventions, the high cost of this modality will be always a limiting factor despite of expected superiority over the per-metal stents, larger multi-center randomized controlled studies are needed for better evaluation of this technique competed to surgical reconstruction and other endovascular techniques.