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Abstract

Objective

To compare endovascular kissing stent (KS) and aortobifemoral bypass (AFB) procedures in patients with bilateral common iliac artery occlusion.

Materials and Methods

This was a single-centre retrospective study. Subjects who underwent treatment for bilateral TASC II C and D common iliac artery occlusion between August 2013 and August 2021 with at least 3 years of follow-up were included in the study. The study group was divided into kissing stent (group A) and aortobifemoral bypass (group B) groups. The subjects’ demographic data (including age, sex, body mass index (BMI), smoking history, comorbid diseases and medications), TransAtlantic Inter-Society Consensus (TASC) II classifications and Rutherford classifications were noted. Preoperative diagnostic data included ankle–brachial index (ABI) measurements and computed tomography (CT) angiography assessments of the aorta and iliac–femoral axis. Intraoperative data (including operative times and complications) and hospital stay data were recorded. Patients were evaluated at the 1^st, 3^rd, 6^th, 12^th, 24^th and 36^th months after the procedure at outpatient visits. The primary patency, primary-assisted patency and secondary patency rates were calculated.

Results

This study included 120 cases. The mean age of the participants in the study group was 66.18 ± 4.63 years (range: 56–78). The BMI of group A was significantly greater than that of group B (23.13 ± 1.36 for group A and 21.51 ± 1.38 for group B, p = 0.001) (Table 1). The rate of TASC D classification in group B was significantly greater than that in group A (p = 0.001; p < 0.01). The operation time of group B was significantly greater than that of group A (mean of 56 min for group A and 210 min for group B, p = 0.001). Moreover, the hospital stay of group B was significantly longer than that of group A (mean of 1 day for group A and 7 days for group B, p = 0.001).

For the follow-up CT angiography measurements, a significant difference was observed between the groups at the 24^th month of follow-up (p = 0.023; p < 0.05). The rate of full patency in patients in group B was significantly greater than that in group A (p = 0.027; p < 0.05). Additionally, the rate of 0%–50% stenosis in patients in group B was significantly lower than that in patients in group A (p = 0.023; p < 0.05). Other comparisons, such as those for CT angiography measurements, were not significant (p > 0.05 for all comparisons). Eleven (n = 11, 18.3%) out of sixty subjects in group A and seven (11.7%) out of sixty subjects in group B underwent secondary interventions (p = 0.444). The calculated primary patency, primary-assisted patency and secondary patency rates at 36 months were 68.3%, 21.7% and 10% for group A and 83.3%, 11% and 6.7% for group B, respectively.

Conclusion

The use of KS and AFB procedures in subjects with bilateral common iliac artery occlusion has comparable long-term patency rates.

Keywords

Kissing stent aortoiliac occlusive disease aortobifemoral bypass

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References

Lee

Huh

Bae

, et al. Comparison between kissing stents and direct surgical bypass for aortoiliac occlusive disease. J Chest Surg 2023; 56(4): 264–271.

Choudhry

Shaw

. Endovascular aorto-iliac reconstruction vs. aortobifemoral bypass as first choice for a durable revascularization for aorto-iliac occlusive disease. Vasc Endovasc Surg 2023; 57(1): 88–92.

Groot Jebbink

Holewijn

Slump

, et al. Systematic review of results of kissing stents in the treatment of aortoiliac occlusive disease. Ann Vasc Surg 2017; 42: 328–336.

Dorigo

Piffaretti

Benedetto

, et al. A comparison between aortobifemoral bypass and aortoiliac kissing stents in patients with complex aortoiliac obstructive disease. J Vasc Surg 2017; 65(1): 99–107.

Amanvermez Senarslan

Yildırım

Bayram

, et al. Results of endovascular treatments of trans-atlantic inter-society consensus C or D aortoiliac occlusive disease involving the aortic bifurcation. Sage Open Med 2023; 11: 20503121231179836.

Colacchio

Squizzato

Boemo

, et al. Open versus endovascular repair with covered stents for complex aortoiliac occlusive disease: cost analysis results. Ann Vasc Surg 2023; 97: 382–391.

Quan

Kim

Jung

, et al. Comparison of results between kissing stent and aortic bifurcated bypass in aortoiliac occlusive disease. Asian J Surg 2020; 43(1): 186–192.

Indes

Pfaff

Farrokhyar

, et al. Clinical outcomes of 5358 patients undergoing direct open bypass or endovascular treatment for aortoiliac occlusive disease: a systematic review and meta-analysis. J Endovasc Ther 2013; 20(4): 443–455.

Aboyans

Ricco

Bartelink

MLEL

, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the european society for vascular surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European stroke organization (ESO)The task force for the diagnosis and treatment of peripheral arterial diseases of the European society of cardiology (ESC) and of the european society for vascular surgery (ESVS). Eur Heart J 2018; 39(9): 763–816.

10.

Salem

Hosny

Francia

, et al. Management of extensive aorto-iliac disease: a systematic review and meta-analysis of 9319 patients. Cardiovasc Interv Radiol 2021; 44(10): 1518–1535.

11.

Palmaz

Encarnacion

Garcia

, et al. Aortic bifurcation stenosis: treatment with intravascular stents. J Vasc Interv Radiol 1991; 2(3): 319–323.

12.

Rutherford

. Options in the surgical management of aorto-iliac occlusive disease: a changing perspective. Cardiovasc Surg 1999; 7(1): 5–12.

13.

Clair

Beach

. Strategies for managing aortoiliac occlusions: access, treatment and outcomes. Expert Rev Cardiovasc Ther 2015; 13(5): 551–563.

14.

Björses

Ivancev

Riva

, et al. Kissing stents in the aortic bifurcation--a valid reconstruction for aorto-iliac occlusive disease. Eur J Vasc Endovasc Surg 2008; 36(4): 424–431.

15.

Dong

Peng

Ren

, et al. Endovascular treatment of aorto-iliac occlusive disease with TASC II C and D lesions: 10 year's experience of clinical technique. BMC Cardiovasc Disord 2023; 23(1): 71.

16.