Background
We sought to investigate the midterm results of kissing self-expanding covered stents
(SECSs) for the reconstruction of aortic bifurcation in complex aortoiliac occlusive
disease.
Methods
Data of consecutive patients who had undergone endovascular treatment for aortoiliac
occlusive disease were screened. Only patients with TransAtlantic Inter-Society Consensus
(TASC) class C and D lesions treated by bilateral iliac kissing stents (KSs) were
included. Midterm primary patency, risk factors, and limb salvage rates were analyzed.
Follow-up results were analyzed using the Kaplan–Meier curves. Cox proportional hazards
models were used to identify the predictors of primary patency.
Results
A total of 48 patients (95.8% men; mean age, 65.3 ± 10.2 years) were treated with
kissing SECSs. Of them, 17 patients had TASC-II class C lesions and 31 had class D
lesions. There were 38 total occlusive lesions, with a mean occlusive lesion length
of 108.2 ± 57.3 mm. The overall mean lesion length was 140.3 ± 60.5 mm, and the mean
length of implanted stents in the aortoiliac arteries was 141.9 ± 59.9 mm. The mean
diameter of the deployed SECSs was 7.8 ± 0.5 mm. The mean follow-up time was 36.5 ± 15.8 months,
and the follow-up rate was 95.8%. At 36 months, the overall primary patency, assisted
primary patency, secondary patency, and limb salvage rates were 92.2%, 95.7%, 97.8%,
and 100%, respectively. Univariate Cox regression analysis revealed that stent diameter
≤7 mm (hazard ratio [HR]: 9.53; 95% confidence interval [CI] 1.56–57.94, P = 0.014) and severe calcification (HR: 12.66; 95% CI 2.04–78.45, P = 0.006) were significantly associated with restenosis. Multivariate analysis showed
severe calcification to be the only significant determinant of restenosis (HR: 12.66;
95% CI 2.04–78.45, P = 0.006).
Conclusions
Kissing SECSs provide good midterm results for the treatment of aortoiliac occlusive
disease. A stent diameter >7 mm is a potent protective factor against restenosis.
Because severe calcification appears to be the only significant determinant of restenosis,
patients with severe calcification require close follow-up.
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Article info
Publication history
Published online: March 02, 2023
Accepted:
February 5,
2023
Received:
May 25,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: This work was supported by the National Natural Science Foundation [grant number 81870350].
Declarations of Interests: None.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
