From the Aortic Bifurcation to the Groin: Long-term Outcomes of Covered Kissing Stent Placement in Combination with Iliofemoral Reconstruction for Extensive Iliofemoral Occlusive Disease

Abstract

The aim of this study was to evaluate outcomes of extensive iliofemoral reconstruction combining both iliac covered kissing stents (ICKS) with stenting of the external iliac artery (SEIA) and/or surgical femoral endarterectomy (SFE). From November 2010 to November 2017, patients with extensive iliofemoral occlusive disease-classified as Trans-Atlantic Inter-Society Consensus class D-treated by ICKS in combination with SEIA and/or SFE were included. Patients received ICKS+SEIA, ICKS+SFE, or ICKS+SEIA+SFE. Demographics, procedure details, and postoperative outcomes were recorded. Primary end points were primary patency (PP), primary assisted patency (PAP), and secondary patency (SP). Long-term patency was assessed by annual clinical and ultrasonographic examination. Among 156 consecutive ICKS procedures performed during the study period, 59 patients were included (81% men; median age, 65years). In all, 32 patients (54%) underwent ICKS+SEIA, 17 (29%) patients underwent ICKS+SFE, and 10 (17%) patients underwent ICKS+SEIA+SFE. Operative indication was either disabling claudication (n=46, 78%) or critical limb-threatening ischemia (n=13, 22%). A total of 92 limbs were revascularized, including 121 covered balloon-expandable stents and 65 self-expanding nitinol stents, with 100% technical success. Thirty-day mortality was 3% (2/59) and 5 (8%) patients suffered from local complications, with no early reintervention. Long-term patency rates were as follows: at 2years, overall PP, PAP, and SP were 82%, 86%, and 96%, respectively; at 5years, overall PP, PAP, and SP were 73%, 79%, and 95%, respectively. After a mean follow-up of 34±29months, 25% (15/59) patients underwent late reinterventions for either de novo iliac or femoral stenosis (n=9), iliac occlusion (n=4), or external iliac in-stent restenosis (n=2). Treatment of extensive iliofemoral occlusive disease involving ICKS in combination with SEIA and/or SFE is safe and effective, providing satisfactory long-term secondary patency, at the price of a significant reintervention rate.