LAUSR

BACKGROUND Endovascular treatment of TASC II D aorto-iliac lesions is now an accepted form of revascularization. We sought to demonstrate that native micro-channel recanalization and orbital atherectomy is a successful recanalization method of TASC II D aorto-iliac lesions refractory to standard recanalization techniques. MATERIALS AND METHODS Four consecutive patients from 2016-2018 with symptomatic TASC-II D Aorto-Iliac Occlusive Disease (AIOD) prohibitive for open bypass and failed traditional prodding guidewire or device recanalization technique were identified and underwent advanced native micro-channel selection and subsequent orbital atherectomy (CSI, St Paul, MN). Native micro-channels of the calcified lesions were probed and traversed with a 0.014" wire. The atherectomy crown was tracked over wire and orbital atherectomy was initiated with the 1.25mm crown starting at the lowest revolution and continued until the micro-channel is sufficiently large to track a 1.2mm balloon for angioplasty. Serial micro-channel angioplasty with exchange for stiffer and/or larger profile wires and balloons was achieved until a covered stent could be safely deployed across the target lesion. Kissing stent technique was then employed to re-create the aortic bifurcation. Viperslide lubricant solution was used in all cases per IFU. Patients were all heparinized to maintain an ACT of 250. Lesion characteristics, survival, limb salvage, patency, and change in clinical symptoms were also analyzed. RESULTS All four patients underwent successful native micro-channel recanalization and orbital atherectomy of the CIA. There were no intra-operative ruptures, embolizations or dissections. All 4 patients presented with unilateral CIA occlusion with contralateral CIA stenosis. Average occlusion lesion length of the CIA was 6.0 cm. Average contralateral stenosis length was 2.3 cm. Kissing stent technique was used in all patients for reconstruction of the aortic bifurcation. At 30 days, all patients had improvement in pain and primary patency of 100%. Long-term follow up at 21.6 months noted continued improvement in symptoms and primary patency of 75%. The fourth patient died at 4 mo from lung cancer with occluded iliac stents by imaging at that time. CONCLUSIONS Native micro-channel recanalization with subsequent orbital atherectomy is an option in high-risk patients with TASC II D aorto-iliac disease who have failed traditional recanalization techniques. Further work in proper patient selection and safe utilization of atherectomy devices in the CIA is needed.