Ten-year Experience with Endologix Afx Endograft for the Treatment of Aortoiliac Occlusive Disease

Endologix AFX unibody stent graft (AFX) has been shown to be effective for the management of complex aortoiliac occlusive disease (AIOD), as a more minimally invasive option than open repair. Additionally, AFX repair is advantageous compared with kissing iliac stents, maintaining a normal aortoiliac morphology. The study examines the mid-term and long-term results of the AFX for treatment of AIOD. A single-center retrospective review was performed of patients treated exclusively for AIOD with the AFX device between 2012 and 2021. One hundred fifteen patients (68 females [58.6%]) were included for evaluation. Primary, assisted primary, and secondary patency rates were evaluated. Clinical improvement after the procedure was assessed using Rutherford classification and ankle/brachial index. One hundred eleven patients underwent AFX repair (68% with lifestyle-limiting intermittent claudication and 32% with critical limb ischemia). Technical success was 97%, with three unsuccessful device passages and one rupture with subsequent open repair. The mean duration of follow-up was 28.2 ± 26.2 months. Complications included groin thrombosis (n = 2 [1.8%]), groin infection (n = 4 [3.6%]), common iliac rupture (n = 2 [1.8%]), iliac dissection (n =1 [0.9%]), and thromboembolic event (n = 3 [2.7%]). The 30-day mortality was 1.8% (2/112). Over the first year, Rutherford stage improved from a mean of 3.48 ± 0.70 to 0.88 ± 1.39 (P < .0001). However, 42 patients (37.5%) required 63 secondary procedures (48 infrainguinal [76.2%] and 15 aortoiliac [23.8%]) over the study period. During the follow-up period, AFX treatment of AOID was associated with primary patency rates of 86 ± 4% at 72 months, primary-assisted patency rates of 95 ± 3% at 108 months, and secondary patency rates of 99 ± 1% at 108 months. The survival rate was 61 ± 8% at 88 months of follow-up (Fig). This study represents the most comprehensive series regarding the use of the Endologix AFX unibody stent graft for the treatment of complex AIOD and is shown to be safe, effective, and durable. In addition, given the high rate of concomitant infrainguinal PAD, the use of the AFX device allows for the maintenance of a normal aortic bifurcation, facilitating further endovascular treatment.