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Comparison between Kissing Stents and Direct Surgical Bypass for Aortoiliac Occlusive Disease
Chung Won Lee1, Up Huh1, Miju Bae1
1Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University School of Medicine, Busan, Korea.
Insights
Kissing stents offer shorter hospital stays and operation times for aortoiliac occlusive disease (AIOD) compared to surgical bypass. This endovascular approach shows superior patency rates, particularly for TASC II C and D lesions.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aortoiliac Occlusive Disease Management
Background:
- The optimal treatment strategy for aortoiliac occlusive disease (AIOD) is not definitively established.
- Direct surgical bypass and endovascular kissing stents are primary treatment options.
Purpose of the Study:
- To compare early and late outcomes of direct surgical bypass versus kissing stents for AIOD treatment.
- To evaluate patency rates and clinical outcomes between the two treatment modalities.
Main Methods:
- Retrospective review of 46 AIOD patients (22 surgical bypass, 24 kissing stents) from 2007-2016.
- Analysis of clinical data including operation time, complications, and length of hospital stay.
- Comparison of primary, assisted primary, and secondary patency rates using Kaplan-Meier analysis.
Main Results:
- Kissing stents significantly reduced operation time (99.5 vs. 316.1 min) and hospital stay (9.1 vs. 16.4 days) (p<0.001).
- Kissing stents demonstrated higher 1, 3, and 5-year primary patency rates (100%, 95.8%, 95.8%) compared to surgical bypass (95.5%, 86.4%, 77.3%).
- Assisted primary and secondary patency rates were also favorable for kissing stents, reaching 100% at 3 and 5 years.
Conclusions:
- Kissing stents are advantageous for treating TASC II C and D aortoiliac occlusive disease lesions.
- Endovascular treatment with kissing stents offers improved outcomes and shorter recovery compared to traditional surgical bypass for selected AIOD cases.
Background:
The optimal management strategy for aortoiliac occlusive disease (AIOD) remains debatable. This study compared early and late outcomes between direct surgical bypass and kissing stents for AIOD treatment.
Methods:
We retrospectively reviewed data, including age, sex, risk factors, comorbidities, symptoms, TransAtlantic Inter-Society Consensus (TASC) II classification, operation time, perioperative complications, in-hospital mortality, and length of hospital stay, from a cohort of 46 patients treated for AIOD (24 with kissing stents and 22 with direct surgical bypass) at Pusan National University Hostpital from January 2007 to December 2016. The primary, assisted primary, and secondary patency rates in both groups were compared.
Results:
The hospital stay (direct surgical bypass vs. kissing stents: 16.36±5.19 days vs. 9.08±10.88 days, p=0.007) and operation time (direct surgical bypass vs. kissing stents: 316.09±141.78 minutes vs. 99.54±37.95 minutes, p<0.001) were significantly shorter for kissing stents. Kaplan-Meier analysis revealed that the primary, assisted primary, and secondary patency rates in the direct surgical bypass group were 95.5%, 95.5%, and 95.5%, respectively, at 1 year; 86.4%, 86.4%, and 95.5% at 3 years; and 77.3%, 77.3%, and 95.5% at 5 years. The primary, assisted primary, and secondary patency rates in the kissing stent group were 100.0%, 100.0%, and 100.0%, respectively, at 1 year; 95.8%, 95.8%, and 100.0% at 3 years; and 95.8%, 95.8%, and 100.0% at 5 years.
Conclusion:
Except for special cases wherein endovascular revascularization is difficult, kissing stents are more advantageous for TASC II C and D lesions.
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