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Outcome Comparison between Open and Endovascular Management of TASC II D Aortoiliac Occlusive Disease. Ann Vasc Surg 2019; 61:65-71.e3. [DOI: 10.1016/j.avsg.2019.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 04/12/2019] [Accepted: 06/02/2019] [Indexed: 11/20/2022]
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Vértes M, Juhász IZ, Nguyen TD, Veres DS, Hüttl A, Nemes B, Hüttl K, Dósa E. Stent Protrusion >20 mm Into the Aorta: A New Predictor for Restenosis After Kissing Stent Reconstruction of the Aortoiliac Bifurcation. J Endovasc Ther 2018; 25:632-639. [DOI: 10.1177/1526602818794959] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To determine the long-term patency of aortoiliac kissing stents and to identify predisposing factors for the development of in-stent restenosis (ISR). Methods: A retrospective analysis was conducted of 105 patients (median age 60.9 years; 64 women) with symptomatic aortoiliac occlusive disease who had kissing stents implanted between 2001 and 2015. The indication for kissing stents was severe claudication in 91 (86.7%) patients and critical limb ischemia in 14 (13.3%). Lesions were TASC A in 52 (49.5%), B in 29 (27.6%), C in 4 (3.8%), and D in 20 (19%) patients. Twenty-five (23.8%) patients had heavily calcified lesions. In all, 210 stents were deployed [180 (85.7%) self-expanding and 30 (14.3%) balloon-expandable]. Follow-up included clinical evaluation, ankle-brachial index measurement, and duplex ultrasonography. Results: The median follow-up was 45 months. The primary patency rates were 93%, 86%, and 77% at 12, 24, and 60 months, respectively. Significant ISR developed in 23 (21.9%) patients (12 unilateral and 11 bilateral). Univariate Cox regression analysis revealed older age [hazard ratio (HR) 0.5, 95% confidence interval (CI) 0.31 to 0.81, p=0.004] and larger aortic diameter (HR 0.42, 95% CI 0.25 to 0.7, p<0.001) to be variables favoring long-term patency, while a longer aortic stent segment (HR 1.56, 95% CI 1.16 to 2.09, p=0.003) and a larger discrepancy between the summed stent diameters and the aortic diameter (HR 1.64, 95% CI 1.01 to 2.65, p=0.043) were associated with ISR development. Multivariate analysis showed a longer aortic stent segment to be the only significant determinant of ISR (HR 1.44, 95% CI 1.02 to 2.01, p=0.035). Conclusion: The kissing stent technique can be performed with good long-term patency. Patients whose iliac stents protrude too far into the aorta need closer follow-up.
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Affiliation(s)
- Miklós Vértes
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | | | - Tin Dat Nguyen
- Medical Faculty, Semmelweis University, Budapest, Hungary
| | - Dániel Sándor Veres
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Artúr Hüttl
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Balázs Nemes
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Kálmán Hüttl
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Edit Dósa
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
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Groot Jebbink E, Mathai V, Boersen JT, Sun C, Slump CH, Goverde PC, Versluis M, Reijnen MM. Hemodynamic comparison of stent configurations used for aortoiliac occlusive disease. J Vasc Surg 2017; 66:251-260.e1. [DOI: 10.1016/j.jvs.2016.07.128] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/27/2016] [Indexed: 10/20/2022]
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The Antegrade Approach Using Transbrachial Access Improves Technical Success Rate of Endovascular Recanalization of TASC C-D Aortoiliac Occlusion in Case of Failed Femoral Access. Ann Vasc Surg 2015; 29:1346-52. [DOI: 10.1016/j.avsg.2015.04.073] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/13/2015] [Accepted: 04/26/2015] [Indexed: 11/23/2022]
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