Comparison between aorto-bifemoral bypass and aorto-iliac kissing stent in patients with complex aorto-iliac obstructive disease

To retrospectively compare early and late results of aorto-bifemoral bypass
and endovascular recanalization with the kissing stent technique in
the management of TASC II C and D lesions in the aorto-iliac district in a
multicentric study
Materials/ Methods: F rom January 2006 to December 2013, 293 open and endovascular interventions
for TASC-II class C and D aorto-iliac obstructive lesions were
performed at three Italian teaching hospitals. In 210 patients the intervention
was performed for aortic and bilateral iliac involvement: an
aorto-bifemoral bypass was performed in 82 patients (Group 1) while in
the remaining 128 an endovascular recanalization with the kissing stent
technique (Group 2). Early results in the two groups were compared with
X2 test. Follow-up results were analyzed with Kaplan-Meyer curves and
compared with log rank test
Results: There were no differences between the two groups in terms of demographic
data, comorbidities, risk factors for atherosclerosis, except for
an higher percentage of females and of diabetic patients in group 2.
Critical limb ischemia was present in 29 patients in group 1 (35.5%) and
in 31 patients in group 2 (24%, p=0.07). Technical success in group 2 was
98.5%; two patients required immediate conversion to open surgery for
iliac rupture. There was one perioperative death in group 1 (mortality rate
1.2%, p=0.2 in comparison with group 2). Four perioperative thromboses
occurred, two in group 1 and two in group 2 (in one case requiring conversion
to open surgical intervention) and no amputations at 30 days were
recorded. Postoperative local and systemic complications occurred in 20
patients in group 1 (24%) and in 13 patients in group 2 (10% p=0.006).
Mean duration of follow-up was 39 months (range 1-108 months). Survival
rates at 6 years were 65% (SE 0.07) in group 1 and 82% (SE 0.05) in group
2 (p=0.07). At the same time interval, primary, assisted primary and secondary
patency rates were similar; reintervention rates were 6% in group
1 (SE 0.05) and 11% in group 2 (SE 0.04; p=0.2).
Conclusion: Endovascular repair of complex lesions of aorto-iliac district with the
kissing stent-technique provided in this multicentric experience similar
satisfactory early and late results to those obtained with open surgery,
however with a lower rate of perioperative complications and a trend
towards better long-term survival.