Endovascular Skirt Reconstruction of Aortoiliac Bifurcation Using Bare-nitinol Stents: ESCORT Technique

Abstract

Background

Endovascular treatment for aortoiliac occlusive disease (AIOD) is still challenging. We propose a stent deployment technique for AIOD using only bare-nitinol stents (BNSs) in a form that is ultimately similar to the normal aortoiliac bifurcation structure.

Methods and case series

The Endovascular Skirt reCOnstruction of aoRToiliac bifurcation using bare-nitinol stents (ESCORT) technique involves primary implantation of a large BNS, with its distal edge being placed just at the edge of the carina by mounting onto 2 pull-through guidewires from the side of an upper extremity followed by V-stenting using BNSs into the pre-implanted BNS at the terminal aorta. The results of experiments showed that this technique can be achieved by the unique structural characteristic of an E-Luminexx Vascular stent (BD, Tempe, AZ, USA) as a main body in which the stent edge can be advanced beyond the catheter tip. This technique without using stent grafts can avoid recrossing of the jailed guidewire and can reduce the procedural and long-term care that is necessary when using stent grafts, and a future cross-over approach may be established also after treatment. Between 2017 and 2021, the ESCORT technique was performed in 7 consecutive cases of AIOD at our institute. The procedural success rate was 100%, and no complication occurred in any of the patients. Symptom resolution was obtained in all patients. Target lesion revascularization (TLR) was performed in 1 patient with extremely severe calcified lesions. Except for the 1 case requiring TLR, at least 2-year patency was confirmed in patients who were followed up. The establishment of a cross-over system was tried in 2 patients after the procedure, and it was successful in both cases.

Conclusion

The ESCORT technique for AIOD is a feasible and beneficial stenting strategy.