Initial experiences with the use of covered stents in endovascular treatment of aortoiliac stenoocclusive diseases

Abstract

Introduction: Treatment for complex aortoiliac stenoocclusive disease traditionally is open surgical repair. Endovascular approach is associated with less perioperative stress for the patient, and is a reasonable solution. Covered stent implantation is an alternative treatment option in this patient population even in the case of aortobiiliac or aortobifemoral bypasses. Objective: Assessing outcomes of aortoiliac covered stent implantation at our vascular center. Method: We retrospectively analysed the data of 36 prospectively registered, consecutive patients who underwent aortoiliac covered stent implantations at our department between the 1th November 2019 and 30th September 2021. Medical records, perioperative complications, preoperative and postoperative Rutherford stages and ankle-brachial index were recorded. One-year survival and primary patency as primary endpoints were presented on Kaplan-Meier curve. Our secondary endpoints were change of the ankle-brachial index and Rutherford stage, and the incidence of the major amputation. Results: 36 patients were included in the study. Mean follow-up time was 12 +/- 6.9 months. TASC C-D aortoiliac lesions were the indication of the procedures in 72.2% (n = 26). Patients had critical limb ischaemia in 44% (n = 16). In 64% (n = 23), interventions were performed via percutaneous puncture. In-hospital stay was 5 +/- 7 days. Perioperative bleeding and reoperation occured in 4 (11.1%) and 6 (16.6%) cases, respectively. Perioperative mortality was zero. The one-year survival and primary patency were 94.3% and 91.4%, respectively. The postoperative Rutherford stage (3 [2] vs. 1 [1]; p < 0.001) and ankle-brachial index (0.4 [0.55] vs. 1 [0.4]; p < 0.001) improved significantly compared to the preoperative ones. Unplanned major amputation was not performed. Conclusion: Significant clinical improvement with low perioperative mortality, acceptable morbidity and high one-year primary patency and survival can be obtained by the use of covered stents in the treatment of aortoiliac stenoocclusive disease. This procedure can be an alternative to open surgical repair.