Clinical Impact of Isolated Infrarenal Aortic Stenosis

To evaluate the clinical characteristics and treatment outcomes in patients with isolated infrarenal aortic stenosis Consecutive patients with isolated infrarenal aortic stenosis who presented with claudication or lower extremity distal embolization were included. Patients with concomitant disease in the iliac and lower extremity arteries and those with less than 2-year follow-up were excluded. Clinical presentation, risk factors, and endovascular treatment were recorded. Clinical evaluation, duplex ultrasound, and ankle-brachial index were performed at 1, 6, 12 months, and annually thereafter. There were 51 patients with aortic stenosis of whom 34 did not fulfill the inclusion criteria leaving 17 for analysis. These were all females, mean age 44 years, range 37-49. All but one patient had three or more risk factors. Fifteen patients had claudication and seven presented with distal embolization. The lesion length was 4 cm in two patients. Seven patients underwent transluminal balloon angioplasty, five had angioplasty followed by stenting, and five had primary stenting. Procedural complications developed in three patients at the access site. After intervention, the pressure gradient across the stenotic area was significantly improved in all patients (49 ± 11.6 mm Hg vs 6.3 ± 2 mm Hg; P < .001). Postoperative ankle-brachial index was improved in all patients (mean preoperative 0.66 ± 0.07 vs postoperative 0.92 ± 0.06; P < .001). The mean follow-up was 3.7 years, range 2-7. Two patients required reintervention with balloon angioplasty at 4 and 5 years and a third one angioplasty plus stenting at 3 years. None of the 17 patients developed life style limiting claudication or distal embolization. Symptomatic isolated infrarenal aortic stenosis is rare but may be found in young females who have at least three cardiovascular risk factors present. Balloon angioplasty alone or angioplasty plus stenting are effective treatments with high success and low complication rates in this cohort of patients