1. Division of Endovascular Interventions
Mount Sinai Hospital
New York
10/24/2018

2. Case presentation
66 year old male
PMHx: of HTN, HLD, NIDDM, CAD s/p 4V CABG, who presents with L>R lower extremity claudication(Rutherford Class II-3). Prior lower extremity bypass and R femoral endarterectomy.
Medications: Lisinopril, Glucophage, Aspirin, Zocor, Carvedilol, Pletal, Gabapentin
Hb- 12.0, INR- 1.0, Creatinine- 1.0

3. Abdominal Aortogram - AIOD

4. Iliac Angiogram

5. CT of abdomen and pelvis
Short segment focal dissection of the infrarenal abdominal aorta extending into the bilateral common iliac arteries, as described above. There is thrombosis of the true lumens bilaterally with contrast filling of the false lumens.
Non obstructive disease of the CFA, SFA and pop. Bilateral single vessel run off.

6. CTA measurements

7. CTA measurements

8. STRATEGY 7Fr RCFA and 17Fr LCFA Shockwave Lithotripsy
Endologix AFX endograft system
Therapeutic anticoagulation- Herparin

10. Mortality and complications after aortic bifurcated bypass procedures for chronic aortoiliac occlusive disease
Number of inserted aortic bifurcated grafts (circles) for chronic limb ischemia in
Denmark. b, The development in mortality (squares) and major complications (circles) at 30 days during the study
period.

13. COBEST trial -A comparison of covered vs bare expandable stents for the treatment of aortoiliac occlusive disease
COBEST demonstrates covered and bare-metal stents produce similar and acceptable results for TASC B lesions. However, covered stents perform better for TASC C and D lesions than bare stents in longer-term patency and clinical outcome
Journal of Vascular Surgery, Volume 55, Issue 5, May 2012

14. Self-Expanding Versus Balloon-Expandable Stents for Iliac Artery Occlusive Disease The Randomized ICE Trial

17. 24-Month Data from the BRAVISSIMO: A Large-Scale Prospective Registry on Iliac Stenting for TASC A & B and TASC C & D Lesions
Ann Vasc Surg 2015; 29: 738–750

18. BRAVISSIMO RCT of SE vs. BE Stents According to TASC Class- No need to preclude TASC C/D lesions
The 24-month primary patency rate after 24 months for the total population was 87.9% (88.0% for TASC A, 88.5% for TASC B, 91.9% for TASC C and 84.8% for TASC D).

19. Early and Midterm Results of Kissing Stent Technique in the Management of Aortoiliac Obstructive Disease

20. Kaplan–Meier curve for primary patency during follow-up with numbers of patients at risk (kissing stents vs other techniques)

21. A comparison between aortobifemoral bypass and aortoiliac kissing stents in patients with complex aortoiliac obstructive disease

23. Aortoiliac Occlusive Disease Rx with Stent-Grafts
Used for combination stenotic & aneurysmal disease, thrombus, clinical evidence for embolization
Less flow disturbance than kissing stents

24. Treatment of Aortoiliac Occlusive Disease with the Endologix AFX Unibody Endograft
Eur J Vasc Endovasc Surg Jul;52(1): doi: /j.ejvs Epub 2016 May 6

25. Endovascular treatment of TransAtlantic Inter-Society Consensus D aortoiliac occlusive disease using unibody bifurcated endografts

26. Endologix AFX unibody stent-graft : potential advantages for the treatment of AIOD
anatomical fixation combined with high columnar strength stent obviates active proximal fixation. Unlike proximal fixation designs, the AFX bifurcated unibody endograft allows for natural blood flow and preserves the native bifurcation
avoids limb competition
eliminates gate cannulation and avoids limb competition in the distal aorta, allows for future endovascular interventions (enables “up and over” procedures)
protects against potentially fatal aortoiliac rupture in heavily calcified lesions

27. Shockwave Peripheral IVL System Components
COMPACT & RECHARGABLE
Portable, IV-pole Mountable
Battery-Powered
No External Connections
IVL Generator
Distal and proximal markers
SIMPLE & QUICK
Smart Magnetic Connection
Push-Button Activated
5 lithotripsy emitters
IVL Connector Cable
INTUITIVE & SAFE
OTW System
Any .014” Guidewire
Standard Technique
180 Lithotripsy Pulses
IVL Catheter
Integrated 60mm semi-compliant balloon