Increasing efficacy of endovascular recanalization with covered stent graft for TransAtlantic Inter-Society Consensus II D aortoiliac complex occlusion

Abstract

We compared the outcomes and the durability of endovascular recanalization (EVR) with the Viabahn (W.L.Gore and Associates, Flagstaff, Ariz) covered stent graft vs traditional aortobifemoral or aortofemoral bypass grafting for complex aortoiliac occlusions. Between 2008 and 2014, 11 unilateral iliac occlusions and 11 aortobiiliac occlusions were treated by EVR. Also collected were data from the last 21 consecutive patients treated in the same period by aortofemoral (n= 6) or aortobifemoral (n= 15) bypass grafting. In accordance with the TransAtlantic Inter-Society Consensus II (TASC II) document, only patients with type D lesions were considered. Kaplan-Meier estimates for patency were calculated, and Cox proportional hazard modeling was performed. The difference in risk factors between the groups was not significant. General anesthesia was required in 100% of the surgical group, and local or locoregional anesthesia was used for EVR. Suprarenal aortic cross-clamping was required in nine of the open surgical procedures (41%). A brachial percutaneous approach was performed in all patients undergoing EVR, and technical success was 100% in both groups. All of the attempts at EVR were successful. At the 2-year follow-up, primary patency did not differ significantly between the endovascular (91%) and surgical (95%) groups. This was seen in the univariate model (hazard ratio [HR], 0.27; 95% confidence interval [CI], 0.02-2.95; P= .28) and in the multivariate model (HR, 0.77; 95% CI, 0.06-10.07; P= .84) for group (HR, 0.58; 95% CI, 0.04-7.72; P= .68), age (HR, 0.89; 95% CI, 0.73-1.08; P= .24), symptoms (HR, 1.98; 95% CI, 0.42-9.46; P= .39), and occlusion (HR, 3.22; 95% CI, 0.51-20.35; P= .21). The average hospital length of stay was shorter for patients treated with ERV than for those treated with open surgery (3.9± 2.2 vs 5.8± 3.1days, respectively; P= .03). The complication rate was 4% for EVR vs 18% in the surgical group (P= .32). At 2years of follow-up, the results of endoluminal bypass grafting with the Viabahn stent to treat complex aortoiliac disease are promising. Longer-term results are needed to fully evaluate the potential benefits and longer-term patency.