SIR 2024
Arterial Interventions and Peripheral Arterial Disease (PAD)
Inge Kaare Tesdal, MD, PhD
Senior Expert
Kantonspital Baden, Switzerland
Financial relationships: Full list of relationships is listed on the CME information page.
Michael Kostrzewa, MD
Radiologist
Kantonspital Baden, Switzerland
Disclosure information not submitted.
Christel Weiss, PhD
Statistician
Universitätsklinikum Mannheim, Germany
Disclosure information not submitted.
A morphologic study of aortoiliac atheromatous disease before and after treatment with kissing stents including long-term follow-up analysing factors associated with primary patency
Materials and Methods:
Between November 2000 and July 2019, endovascular reconstruction of the aortic bifurcation was offered to all symptomatic patients showing occlusive disease involving the aortoiliac bifurcation. Digital subtraction angiography (DSA) and a computed tomography (CT) scan were performed to precisely assess the pathologic anatomy of the aortoiliac bifurcation. 167 patients (98 men and 69 women, mean age 62.1±10.3 years, range 34-92 years) were treated. 87 (52.1%) were treated as outpatients. For comparison of parameters, Student's t-test was used (p < 0.05 level of significance). A log-rank test and cox regression analysis were used to compare differences in
patency and possible predictors such as the pathologic anatomy of the aortoiliac bifurcation, Tayside classification and TASC type
Results:
Based on baseline angiography and CT, five patterns (biftype) of underlying atheromatous disease were identified: unilateral (Type A lesion), bilateral (Type B lesion), aortic (Type C lesion), aortic and unilateral (Type D lesion), aortic and bilateral (Type E lesion). The majority of patients (92) had biftype B (55%) followed by biftype E (29%). The 10 year survival and primary patency rates (target region) were 62.3 % and 86.8%, respectively. The 10 year primary patency rate in the vessel region was 71.8%. Cox-regression analysis indicated a significantly higher risk of restenosis in biftype A, B, C and D compared to biftype E (p=0.0237, Hazard-Ratio 4.25). Further negative prognostic parameters for restenosis included femoropopliteal disease (p=0.03) and dialysis (p=0.0004). The Tayside classification and TASC type showed no significant differences in patency
Conclusion: This study suggest that the pattern of aortoiliac atheromatous disease and the distribution of the underlying lesions have a significant influence of the primary patency rates after treatment with kissing stents. Further factors predicting lower primary patency are femoropopliteal disease and dialysis