Background
The endovascular treatment of peripheral artery obstructive disease in Trans-Atlantic
Inter-Society (TASC) C and D lesions involving the aortic bifurcation is a matter
of debate. The aim of this study is to evaluate the technical and clinical success
of kissing stenting in this context and to analyze predictors of outcome.
Methods
All patients treated for aortoiliac TASC C and D lesions with kissing stenting (from
2012 to 2017) in a 6-year period were retrospectively analyzed. Preoperative anatomical
features were evaluated by reviewing computed tomography angiography images to identify
severe iliac calcifications (SICs) versus not SIC (NSICs). Primary end points were
as follows: technical success (TS), procedural success, primary patency (PP), and
clinical success (CS). Secondary end points were as follows: secondary patency, assisted
patency, survival, mid-term procedure-related complications, and risk factors that
affected TS and mid-term results.
Results
In a 6-year period, 51 patients fulfilled the inclusion criteria. TS was achieved
in 49 (96.1%) cases. Thirty-one patients (60.8%) received a dual antiplatelet therapy
(DAPT) for at least 1 month after the procedure. 30-day CS was 94.1%. Median follow-up
was 45.7 months (IQR: 24.5, 8–86 range). The CS was 92.6% at 3 years, with a PP of
86.8% and a secondary patency of 93.2% at 3 years. Six (13.2%) iliac axis occluded
during the first follow-up year. NSIC was statistically and independently associated
with a lower PP (73% vs. 96%, P = 0.03); DAPT was statistically and independently associated with higher PP than
single antiplatelet therapy (96% vs. 75%, P = 0.03); these results were confirmed by Cox regression analysis (HR: 0.14, 95%,
IC: 0.01–0.89, P = 0.05 for DAPT analysis; HR: 6.8, 95%, IC: 1.21–59, P = 0.05 for NSIC analysis).
Conclusions
Endovascular treatment for TASC C–D is an effective technique. Postoperative stent
occlusion is higher in patients with no DAPT and it usually occurs during the first
postoperative year. Preoperative NSIC lesions are associated with reduced PP at 3 years
of follow-up.
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Article info
Publication history
Published online: September 01, 2020
Accepted:
July 31,
2020
Received:
June 11,
2020
Footnotes
Conflict of interest: None.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
