Stent Configurations in Aortoiliac Occlusive disease: A Systematic Review and Meta-Analysis

To evaluate which endovascular stent configuration at the aortic bifurcation offers superior outcomes for aorto-iliac occlusive disease (AIOD).

Studies reporting outcomes for endovascular reconstruction for AIOD, for TransAtlantic Inter-Society Consensus (TASC) C and D lesions were included in the review. Data for primary, primary-assisted and secondary patency were extracted (full-text articles or reconstructed from published Kaplan Meier curves).

This review included 12 studies, including 1027 patients (177 Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB), 850 kissing stent). Most studies were retrospective cohort studies with moderate methodological quality. Median follow-up was 20 months for primary patency, and 48 months for assisted and secondary patency. CERAB and kissing stent techniques showed similar primary patency (p=0.24). Primary-assisted patency was slightly lower for CERAB but not statistically significant (p=0.051). Secondary patency favored CERAB (p=0.045). At two years, CERAB had primary patency of 90%, primary-assisted patency of 87%, and secondary patency of 100%. Kissing stents showed primary patency of 91%, primary-assisted patency of 92%, and secondary patency of 96%.

Both stent types yielded positive results, but current data does not favor one configuration. Current studies on this topic are low quality. At present, the method of endovascular intervention for AIOD could be left to clinical expertise, although hemodynamic studies may provide insights. Randomized trial data or post-market registries are needed to ascertain superiority of any stent configuration in this disease process.