Midterm results of kissing stent reconstruction of the aortoiliac bifurcation

Comparison of Covered Stent versus Bare-Metal Stent Implantation in Aortoiliac Occlusive Disease: A Systematic Review and Meta-Analysis

PURPOSE

This systematic review aimed to compare covered stent (CS) and bare-metal stent (BMS) implantation in treating aortoiliac occlusive disease.

MATERIALS AND METHODS

Comprehensive searches were conducted in the MEDLINE, Embase, and Cochrane Library databases for all pertinent studies. The end points included primary patency, secondary patency, freedom from target lesion revascularization (TLR), technical success, ankle-brachial index (ABI) improvement, periprocedural adverse events, major amputation, and mortality. Odds ratios (OR) or risk differences with 95% CIs were used to estimate the binary variables. The continuous variables were presented as mean difference (MD) with 95% CI.

RESULTS

Ten studies involving 1,861 limbs were included. For overall outcomes, compared with BMS, CS showed significantly superior in freedom from TLR (OR, 3.00; 95% CI, 1.05-8.51; P = .04) and ABI (MD, 0.03; 95% CI, -0.00 to 0.06; P = .04). No significant differences were found in technical success, primary patency (at 12, 24, 36, and 60 months), secondary patency, periprocedural adverse events, major amputation rates, and early mortality. Subgroup analyses favored CS in ABI improvement (MD, 0.06; 95% CI, 0.02-0.11; P = .01) after propensity score matching, and covered balloon-expandable stents demonstrated certain advantages in freedom from TLR (OR, 4.60; 95% CI, 1.79-11.81; P = .002). Additionally, no significant difference in primary patency at 36 months between the 2 groups with Trans-Atlantic Inter-Society Consensus D or severe calcification lesions.

CONCLUSIONS

Compared with BMS, CS presented advantages in reducing TLR and enhancing ABI improvement. Meanwhile, CS demonstrated comparable technical success, primary patency, secondary patency, periprocedural adverse events, major amputation rates, and early mortality.

Safety and Efficacy of Stent-Graft in the Treatment of Aortoiliac Artery Occlusive Disease: A Multicenter Study of Short-Term and Medium-Term Outcomes

BACKGROUND

To evaluate the short-term and mid-term safety and efficacy of stent-graft compared with bare stents for treatment of aortoiliac occlusive disease (AIOD).

METHODS

One hundred eighty three patients diagnosed with AIOD who received stent implantation at 3 vascular centers in north China between January 2019 and December 2021 were enrolled. Patients were divided into those undergoing stent-graft (Group A; n = 67) or bare stent (Group B; n = 116) implantation for retrospective cohort analysis. Efficacy was assessed as surgical success rate and rate of freedom from clinically driven target lesion reintervention at each follow-up time point. Safety was assessed by the rate of perioperative complication, major limb amputation, and aortoiliac artery-related mortality.

RESULTS

There were no preoperative baseline differences between the 2 groups (P > 0.05). The surgical success was 91.04% for Group A, significantly higher than that for Group B (79.31%; P < 0.05). Incidence of perioperative complications was 2.98% for Group A, significantly lower than that for Group B (9.48%, P < 0.05), as was the rate of major limb amputation (A: 1.49% vs. B: 5.17%) and aortoiliac artery-related mortality (A: 1.49% vs. B: 4.31%), although these 2 indicators were not significantly different (P > 0.05). Follow-up rates were 91.8% for the total follow-up time of 3 years. Kaplan-Meier survival curve analysis gave significantly higher 1-year and 2-year freedom from clinically driven target lesion reintervention for Group A (98.51% and 95.52%) than for Group B (95.69% and 89.66%, P < 0.05).

CONCLUSIONS

Stent-graft is more effective and safer than bare stent in the treatment of AIOD.

Efficacy and Safety of Covered Stents Versus Bare-Metal Stents for Aortoiliac Occlusive Disease: A Systematic Review and Meta-Analysis

PURPOSE

This study aimed to assess the efficacy and safety outcome of covered stents (CSs), as compared with bare-metal stents (BMSs), for the treatment of patients with aortoiliac occlusive disease (AIOD).

MATERIALS AND METHODS

A systematic literature search was conducted in PubMed, Embase, and Cochrane Library up to August 2023 to identify all studies comparing efficacy and safety outcomes of CSs versus BMSs for treating AIOD. Our outcome was primary patency, secondary patency, technical success, ankle-brachial index (ABI) variation, target lesion revascularization (TLR), limb salvage, complications, and long-term survival. Dichotomous outcomes were pooled as relative risks (RR) or hazard ratio with the 95% confidence interval (CI). Continuous outcomes were pooled as weighted mean differences and 95% CI. Model selection was based on the heterogeneity of the included studies.

RESULTS

There were 10 studies (2 randomized controlled trials, 8 retrospective cohort studies), comprising 1676 sample size. Compared with BMSs, CSs use was associated with better primary patency of patients with a Trans-Atlantic Inter-Society Consensus II (TASC) D lesion (RR, 1.15, 95% CI, 1.04 to 1.27, p=0.007), TLR (RR, 0.39, 95% CI, 0.27 to 0.56, p<0.001), technical success (RR, 1.01, 95% CI, 1.00 to 1.02, p=0.010), and long-term survival (RR, 1.06, 95% CI, 1.01 to 1.11, p=0.020). There is no difference between CSs and BMSs regarding primary patency of all patients, secondary patency, variation in ABI, limb salvage, and complications.

CONCLUSIONS

Compared with BMSs, CSs used in AIOD was associated with more favorable primary patency in patients with TASC D lesions, TLR, technical success rates, and patient long-term survival. These results provide evidence of the advantages of using CSs for AIOD treatment. Future studies focusing on long-term variations in ABI, primary patency of different degrees of calcification, vascular segments, and TASC classification are warranted.

CLINICAL IMPACT

Although several studies evaluated the clinical efficacy of CS in the context of AIOD treatment, the significance and consistency of these findings were not determined to date. We found that CS was used in AIOD associated with better technical success rate, long-term patient survival, lower target lesion revascularization, and higher primary patency of patients with a Trans-Atlantic Inter-Society Consensus II D lesion when compared with BMSs. Our study provides evidence supporting the superiority of CSs over BMSs in the treatment of AIOD, and furnishing clinicians with guidance for treatment decisions.