Outcomes of Covered Versus Bare Metal Stents for the Treatment of Aortoiliac Occlusive Disease

Type of Research: Single-center retrospective cohort study. Key Findings: Among 209 patients with endovascular aortoiliac artery occlusion were included, the 5-year primary patency rate was similar in 135 CS patients and 74 BMS patients (83.4% vs 86.9%). Severe calcification was the only independent risk factor for primary patency rate. Take home Message: The overall effect of endovascular treatment of aortoiliac artery occlusion disease is good. CSs is more suitable for complex and severe calcification lesions. Objective We retrospectively compared the clinical outcomes of self-expanding covered stents (SECSs) and bare metal stents (BMSs) in the treatment of aortoiliac occlusive disease (AIOD) at a single center between 2016 and 2022. Methods All AIOD patients receiving endovascular therapy at a single center from January 2016 to October 2022 were continuously analyzed, including patients with lesions of all classes according to the Trans-Atlantic Inter-Society Consensus II (TASC-II). Relevant clinical and baseline data were collected, and propensity score matching was performed to compare CSs and BMSs in terms of baseline characteristics, surgical factors, 30-day outcomes, 5-year primary patency and limb salvage. The follow-up results were analyzed by Kaplan‒Meier curves. Cox proportional hazard models were used to identify predictors of primary patency. Results A total of 209 patients with AIOD were enrolled in the study, including 135 (64.6%) patients in the CS group and 74 (35.4%) patients in the BMS group. Surgical success rates (100% vs. 100%, p=1.00), early (< 30-day) mortality rates (0% vs. 0%, p=1.00), cumulative surgical complication rate (12.0% vs. 8.0%, p=0.891), 5-year primary patency rate (83.4% vs. 86.9%, p=0.330), secondary patency rate (96% vs. 100%, p=0.570) and limb salvage rate (100% vs. 100%, p=1.00) did not exhibit significant differences between the two groups. Patients in the CS group had a lower preoperative ankle-brachial index (ABI) (0.48±0.26 vs. 0.52±0.19; p=0.032), more cases of complex AIOD (especially TASC D) (47.4% vs. 9.5%; p < 0.001), more chronic total occlusive (CTO) lesions (77.0% vs. 31.1%; p < 0.001) and more severe calcification (20.7% vs. 14.9%; p < 0.036). After propensity score matching, 50 patients (25 CSs and 25 BMSs) were selected. The results showed that only severe calcification (32.0% vs. 8.0%, p=0.034) and ABI increase (0.45±0.15 vs. 0.41±0.22, p=0.038) were significantly different between the groups. In terms of surgical factors, patients in the CS group had more use of bilateral femoral or combined brachial artery percutaneous access (60.0% vs. 12.0%, p < 0.001), more number of stents used (2.3±1.2 vs. 1.3±0.7, p < 0.001), longer mean stent length (9.3±3.3 vs. 5.8±2.6, p < 0.001) and more catheter-directed thrombolysis (CDT) treatment (32.0% vs. 4.0%, p=0.009). Multivariate Cox survival analysis showed that severe calcification (HR, 1.32; 95% CI, 1.04-1.85; P=0.048) was the only independent predictor of the primary patency rate. Conclusions All patients with AIOD who underwent endovascular therapy were included and achieved good outcomes with both CSs and BMSs. The influence of confounding factors in the two groups was minimized by propensity score matching, and the five-year patency rates were generally similar in the unmatched and matched cohorts. Postoperative hemodynamic improvement was more obvious in patients in the CS group.For more complex lesions, CS is recommended to be preferred. Especially for severe calcification lesions, which is the only independent predictor of primary patency, CS showed obvious advantages.Further studies with more samples are needed to investigate the role of stent types in AIOD treatment. We retrospectively compared the clinical outcomes of self-expanding covered stents (SECSs) and bare metal stents (BMSs) in the treatment of aortoiliac occlusive disease (AIOD) at a single center between 2016 and 2022. All AIOD patients receiving endovascular therapy at a single center from January 2016 to October 2022 were continuously analyzed, including patients with lesions of all classes according to the Trans-Atlantic Inter-Society Consensus II (TASC-II). Relevant clinical and baseline data were collected, and propensity score matching was performed to compare CSs and BMSs in terms of baseline characteristics, surgical factors, 30-day outcomes, 5-year primary patency and limb salvage. The follow-up results were analyzed by Kaplan‒Meier curves. Cox proportional hazard models were used to identify predictors of primary patency. A total of 209 patients with AIOD were enrolled in the study, including 135 (64.6%) patients in the CS group and 74 (35.4%) patients in the BMS group. Surgical success rates (100% vs. 100%, p=1.00), early (< 30-day) mortality rates (0% vs. 0%, p=1.00), cumulative surgical complication rate (12.0% vs. 8.0%, p=0.891), 5-year primary patency rate (83.4% vs. 86.9%, p=0.330), secondary patency rate (96% vs. 100%, p=0.570) and limb salvage rate (100% vs. 100%, p=1.00) did not exhibit significant differences between the two groups. Patients in the CS group had a lower preoperative ankle-brachial index (ABI) (0.48±0.26 vs. 0.52±0.19; p=0.032), more cases of complex AIOD (especially TASC D) (47.4% vs. 9.5%; p < 0.001), more chronic total occlusive (CTO) lesions (77.0% vs. 31.1%; p < 0.001) and more severe calcification (20.7% vs. 14.9%; p < 0.036). After propensity score matching, 50 patients (25 CSs and 25 BMSs) were selected. The results showed that only severe calcification (32.0% vs. 8.0%, p=0.034) and ABI increase (0.45±0.15 vs. 0.41±0.22, p=0.038) were significantly different between the groups. In terms of surgical factors, patients in the CS group had more use of bilateral femoral or combined brachial artery percutaneous access (60.0% vs. 12.0%, p < 0.001), more number of stents used (2.3±1.2 vs. 1.3±0.7, p < 0.001), longer mean stent length (9.3±3.3 vs. 5.8±2.6, p < 0.001) and more catheter-directed thrombolysis (CDT) treatment (32.0% vs. 4.0%, p=0.009). Multivariate Cox survival analysis showed that severe calcification (HR, 1.32; 95% CI, 1.04-1.85; P=0.048) was the only independent predictor of the primary patency rate. All patients with AIOD who underwent endovascular therapy were included and achieved good outcomes with both CSs and BMSs. The influence of confounding factors in the two groups was minimized by propensity score matching, and the five-year patency rates were generally similar in the unmatched and matched cohorts. Postoperative hemodynamic improvement was more obvious in patients in the CS group.For more complex lesions, CS is recommended to be preferred. Especially for severe calcification lesions, which is the only independent predictor of primary patency, CS showed obvious advantages.Further studies with more samples are needed to investigate the role of stent types in AIOD treatment.