Different Techniques in Endovascular Treatment of Obstructive Aortoiliac Disease

Objectives: Obstructive aortoiliac disease must be considered a chal- lenging treatment lesion 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 116 patients treated for aortoiliac disease with endovascular technique from March 2015 to December 2018 at our institution. We considered in our study 64 patients with obstructive disease and divided our series in standard stenting group (32 patients) and complex technique group (32 patients). In the complex group, 21 kissing stents, 6 bifurcated endografts, and 5 covered reconstruction of aortic bifurcations were included. For each group, we analyzed comorbidities, and morphologic preoperative and intraopera- tive details. Early Results were analyzed in terms of 30-day thrombosis, amputation, and death. Follow-up results were analyzed by life-table an- alyses (Kaplan-Meier curves) in terms of primary and secondary graft patency, assisted primary patency, freedom from reintervention, amputa- tion-free survival, and overall survival. Univariate Cox regression analysis was performed to identify risk factors and intraoperative details associ- ated with primary stent graft patency. The median follow-up was 12 months. Results: The mean age was 64 6 11 years. At 30 days, we did not record any cases of amputations or deaths. The rate of thrombosis was of 3.1 and 9.4 (c2 1,067; P ¼ .3) in the standard stenting and complex technique groups, respectively. During follow-up, primary patency in both groups was quite similar (82% vs 90%; log-rank 0.088; P ¼ .7; Fig), secondarypatency 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 mid term Results. Com- plex techniques, although they are more technically demanding and time consuming strategies, may be performed with similar results to those obtained in standard stenting procedures.