Analysis of pre-operative CT-scan can help predict technical failure of endovascular treatment of TASC C-D aorto-iliac chronic total occlusions

Abstract Aims To evaluate if features of occlusion analyzable on pre-operative CT-scan could predict risks of technical failure or iliac rupture of endovascular treatment of TASC C-D aorto-iliac chronic total occlusion (CTO). Methods and results All patients treated by endovascular techniques for a TASC C-D aorto-iliac CTO between 2009 and 2016 were included (107 patients, 148 iliac arteries). We evaluated the location of the occlusion and the importance of the arterial calcifications. For this factor, patients were divided into 3 groups : the Black occlusion group (BO) with mild or no calcifications, the white occlusion group (WO) with moderate no protrusive calcifications and the white protrusive occlusion group (WPO) with heavy endoluminal calcifications. Technical failure occurred in 11 iliac arteries and per-operative iliac rupture in 6. The location in the external iliac artery (EIA) is the most significate risk factor of technical failure in univariate (OR = 9.93;p = 0.0012) and multivariate analysis (OR = 15.26;p = 0.0006). The presence of heavy endoluminal calcifications is a further significate risk factor (OR = 13.88;p = 0.0365). Rupture rate was comparable between the 3 groups. Conclusions Pre-operative CT-scan can predict risk of technical failure but not of iliac rupture.