Comparison of endovascular kissing stent and aortobifemoral bypass in patients with aortoiliac occlusive disease

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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