AAA 23. Different Techniques in Endovascular Treatment of Obstructive Aortoiliac Disease

Objective: Obstructive aortoiliac disease must be considered chal- lenging treatment lesions for vascular surgeons. The aim of our study was to evaluate the outcomes of endovascular treatment of these lesions in terms of early and midterm results, comparing standard iliac stenting with more complex techniques, including kissing stent, covered recon- struction of aortic bifurcation, and bifurcated endograft deployment. Methods: A retrospective review was conducted of 142 patients treated for aortoiliac disease with endovascular technique from March 2015 to June 2019 at our institution. We considered in our study 80 patients with obstructive disease and divided our series into a standard stenting group (35 patients) and complex technique group (45 patients). In the complex technique group, 23 kissing stents, 12 bifurcated endografts, and 10 covered reconstructions of aortic bifurcation were included. For each group, we analyzed comorbidities and morphologic preoperative and intraoperative details. Early results were analyzed in terms of 30- day thrombosis, amputation, and death. Follow-up results were analyzed by life-table analyses (Kaplan-Meier curves) in terms of primary and sec- ondary graft patency, assisted primary patency, freedom from reinterven- tion, amputation-free survival, and overall survival. Univariate Cox regression analysis was performed to identify risk factors and intraopera- tive details associated with primary stent graft patency. Median follow-up was 12 months. Results: The mean age of patients was 65 6 11 years. At 30 days, we did not record any cases of amputation and death. The rate of thrombosis was of 8.9 and 5.0 ( c2 , 1.353; P ¼ .2) in the standard stenting and complex technique groups, respectively. In the follow-up, primary patency in both groups was similar (85.5% vs 95%; log rank, 1.530; P ¼ .2); secondary patency and limb salvage for patients with critical limb ischemia, freedom from reintervention, and overall survival did not differ in the two groups. Univariate analysis did not find any factors affecting primary patency. Conclusions: In our experience, endovascular treatment of obstructive aortoiliac disease offered satisfactory early and midterm results. Complex techniques, although they are more technically demanding and time- consuming strategies, may be performed with results similar to those ob- tained in standard stenting procedures.