Midterm Outcomes on Primary Endovascular Treatment of 395 Aortoiliac Occlusive Disease Patients: A Single-Center
Ender Özgün Çakmak1, Emrah Bayam1, Fatih Yilmaz1
1Department of Cardiology, 448249University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey.
Insights
Endovascular treatment with stenting is safe and effective for all Trans-Atlantic Inter-Society Consensus II (TASC) aortoiliac lesions. This study shows excellent long-term patency rates and few complications for patients undergoing this procedure.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aortoiliac Disease Management
Background:
- Aortoiliac occlusive disease poses significant challenges in vascular intervention.
- Trans-Atlantic Inter-Society Consensus II (TASC) classification stratifies lesion complexity.
- Optimal endovascular strategies for complex TASC C and D lesions require ongoing evaluation.
Purpose of the Study:
- To evaluate the effectiveness and safety of endovascular treatment for all TASC A-D aortoiliac lesions.
- To assess long-term primary and secondary patency rates following stenting.
- To identify factors associated with decreased patency in aortoiliac occlusive disease.
Main Methods:
- Retrospective observational cohort study of 395 patients treated between January 2015 and December 2017.
- Analysis of technical success, in-hospital mortality, and median follow-up of 36 months.
- Kaplan-Meier analysis of primary and secondary patency rates stratified by TASC classification.
Main Results:
- Technical success rate was 96.5% with an in-hospital mortality of 1.2%.
- Excellent 1- and 5-year primary patency rates: TASC A&B (99%, 85%), TASC C (90%, 78%), TASC D (90%, 74%).
- Previous peripheral revascularization, lower age, and TASC C/D classification were associated with decreased primary patency.
Conclusions:
- Endovascular stenting demonstrates acceptable effectiveness and safety for all TASC classes of aortoiliac occlusive disease.
- The procedure offers excellent long-term primary and secondary patency rates with minimal complications.
- Risk factors for reduced patency include prior revascularization and more complex TASC lesion classifications.
Abstract:
We report the results of endovascular treatment of Trans-Atlantic Inter-Society Consensus II (TASC) A&B, TASC C, and TASC D aortoiliac lesions in a single vascular center. In this retrospective, observational cohort study, we analyzed 395 patients (mean age 61.2 ± 9.0; 359 men) between January 2015 and December 2017. Technical success was achieved in 96.5%; in-hospital mortality was 1.2% (n = 5). Median follow-up was 36 months (range 24-49 months). After 1 and 5 years, the primary patency rates were 99% and 85% for TASC A&B, 90%, and 78% for TASC C, and 90% and 74% for TASC D. Secondary patency rates were 99% and 90% for TASC A&B, 98% and 65% for TASC C, and 97% and 65% for TASC D. Previous peripheral revascularization (hazard ratio: 1.76, 95% CI: 1.01-3.08, P = .04) was associated with decreased primary patency along with lower age, TASC C, and TASC D class. This analysis reported the acceptable effectiveness and safety of stenting for all types of aortoiliac occlusive disease in a modern setting, with few complications and excellent long-term primary and secondary patency rates.
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