Comparaison Between Endovascular Approach and Aorto-Bifemoral Bypass for Tasc D Aorto-iliac Disease Patients Treated
Joel Sousa1, João Neves1, André Ferreira1
1Hospital de S.João, Porto, Portugal.
Insights
For TASC D aortoiliac lesions, endovascular treatment offers similar patency and limb salvage to open surgery, despite lower technical success rates. This less invasive approach warrants consideration as a primary option.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aortoiliac Disease Treatment
Background:
- Endovascular techniques show promise for TASC D aortoiliac lesions, but evidence comparing outcomes is limited.
- Optimal treatment strategies for complex aortoiliac disease remain debated.
- This study addresses the need for comparative data on endovascular versus open surgical approaches.
Purpose of the Study:
- To compare patency rates, cost-effectiveness, and quality of life between endovascular and open surgical treatments for TASC D aortoiliac lesions.
- To evaluate the safety and efficacy of these two distinct treatment modalities in a real-world setting.
Main Methods:
- Retrospective analysis of 59 patients with TASC D aortoiliac disease treated between 2011-2017.
- Patients were divided into Open Group (aorto-bifemoral bypass, n=27) and Endo Group (endovascular intervention, n=32).
- Quality of life was assessed using validated questionnaires; baseline characteristics and outcomes were analyzed.
Main Results:
- Open surgery had higher technical success (100% vs 65%) and infection rates (11.1% vs 0%).
- Endovascular procedures were more expensive but resulted in lower ICU stay.
- Patency and limb salvage rates were similar between groups (96.3% vs 100%); quality of life showed no significant differences.
Conclusions:
- While open surgery offers higher initial technical success, endovascular treatment provides comparable patency and limb salvage for TASC D lesions.
- The endovascular approach is less invasive, with lower infection rates and reduced ICU utilization.
- These findings support considering an 'endovascular first' strategy for selected patients with complex aortoiliac disease.
Introduction:
In the last few years, endovascular approaches have been demonstrating remarkable results on the treatment of aortoiliac TASC D lesions. However, the results remain conflictuous and proper evidence regarding the best treatment option for this group of patients is still lacking. Through this work, we aim to compare patency, cost-effectiveness and quality of life in patients successfully treated by these two approaches.
Methods:
Patients with TASC D aorto-iliac disease, from two independent Vascular Surgery Centers, treated either by open surgery and endovascular intervention between 2011- 2017, were retrospectively analyzed and consecutively included (n=59). Patients were then divided in 2 groups: Open Group (OG), in which aorto-bifemoral bypass was performed (n=27); and Endo Group (EG), in which an endovascular approach was preferred (n=32). Surgical decision between these two procedures was made individually by the surgeon, according to clinical criteria. Baseline characteristics (age, diabetes, smoking history, chronic kidney disease and rutherford grade of ischemia) were also evaluated. Quality of life (QoL) was later assessed by means of three physical and telephonic validated questionnaires (EQ-5D-5L; peripheral artery questionnaire; walking impairment questionnaire).
Results:
There were significant statistical differences between the OG and EG, regarding mean age (62 vs 65 years, p=0,044) and tobacco use (100 vs 75%, p=0,05), but both groups were comparable for the remaining baseline characteristics. Technical success was achieved in 100% of the cases of OG, while only in 65% was it obtained in the EG (p=0,001). Consequently, re-intervention rate was higher in the later. Regarding infection rate, it was significantly higher in the OG (11.1% vs 0%, p=0,05). No differences between groups were found regarding limb salvage (96,3% vs 100%, p> 0,05). Cost-analysis revealed that endovascular procedures were significantly more expensive than open interventions (1053€ vs 2080€, p=0,001), with similar inpatient lengths. Nonetheless, ICU occupation was significantly lower in the EG (3,8 vs 0,05 days, p=0,05). No differences between groups were found in the questionaries of QoL (p>0,05).
Conclusion:
Despite higher rates of technical success in the OG, patency and limb salvage seems quite similar between the two techniques. Also, endovascular approach of the aortoiliac sector remains significantly less invasive than the conventional alternative. Based on this, and despite the higher success rate of open surgery, shouldn't we give an opportunity to the "endovascular first" approach?
Related Concept Videos
02:57The Sense of Self: Reflected Self-Appraisal and Social Comparison
01:13Multiple Comparison Tests
It would be easy to compare two samples using a significance alpha level of 0.05. In other words, there is only one sample pair to be compared. However, it would be difficult to identify a significantly different sample if the number...
02:54Evolutionary Relationships through Genome Comparisons
01:24Comparison Between Electrical And Gravitational Forces
Since both are inverse square law forces, the distance gets canceled when the ratio of the two forces is considered. Instead, the ratio of the electrical and gravitational forces depends on...
01:24Comparison between RL and RC circuits
02:26Molecular Comparison of Gases, Liquids, and Solids