Comparative Analysis of Outcomes of Unibody Endoprosthesis and Aortobifemoral Bypass for Aortoiliac Occlusive Disease

Abstract

Aortoiliac occlusive disease (AIOD) has traditionally been treated with aortobifemoral bypass (ABF). Unibody endograft (UBE) for AIOD, however, has been increasingly utilized in selected patients. We report outcomes of patients undergoing ABF or UBE for AIOD. Patients (2016-2021) undergoing elective ABF or UBE with a unibody device for AIOD were identified at an academic institution. Chi-square and Kaplan-Meier analysis were used to evaluate outcomes by group. One hundred thirty-one patients undergoing UBE or ABF were screened, with 82 included. Twenty-one patients underwent UBE (25.6%) and 61 (74.4%) underwent ABF. UBE patients were older (63.8 vs. 58.2years; P=0.01), with a higher prevalence of diabetes (52.4 vs. 19.7%; P=0.004). Significant differences were seen between UBE and ABF including a shorter surgery length (214 vs. 360min; P=0.0001), less blood loss (300 vs. 620mls; P=0.001), larger minimum aortic diameter (14.6 vs. 12.6; P=0.0006), larger common iliac artery (9.5 vs. 7.9; P=0.005) and lower postoperative ankle-brachial index (0.8 vs. 0.9; P=0.04). There were no differences in TASC C/D iliac lesions in the UBE than ABF group (66.6% vs. 63.9%; P<0.82) or Trans-Atlantic Inter-Society Consensus classification femoropopliteal lesions. Unadjusted analysis revealed no significant differences between UBE and ABF for 30-day mortality (0 vs. 1.6%; P=1), stroke (0 vs. 3.3%; P=1), or major adverse cardiac events (4.8 vs. 4.9%; P=1). There were no significant differences in mid-term surgical outcomes over a mean follow-up period of 23.7months between UBE and ABF groups; specifically endovascular (0 vs. 8.2%; P=0.3) or open/hybrid reintervention (9.5 vs. 14.8%; P=0.7) with similar limb occlusion (4.8 vs. 27.8; P=0.12). Kaplan-Meier estimated primary, primary-assisted, and secondary patency at 36months were similar with 94%, 100%, and 94% for UBE and 86%, 95%, and 86% for ABF, respectively. Estimated survival at 36months was 95% for UBE and 97% for ABF (P=0.8). Equivalent outcomes were seen between AIOD treated with UBE or ABF in similar patient populations. Mid-term outcomes such as reintervention and patency are similar for UBE and ABF. We still recommend ABF over UBE as a primary modality of treatment in surgically fit patients with greater complexity aortoiliac lesions and with smaller arterial diameters, especially women.