Comparison between aorto-bifemoral bypass and aorto-iliac kissing stent in patients with complex aorto-iliac obstructive disease

To retrospectively compare early and late results of aorto-bifemoral bypass and endovascular recanalization with the kissing stent technique in the management of TASC II C and D lesions in the aorto-iliac district in a multicentric study Materials/ Methods: F rom January 2006 to December 2013, 293 open and endovascular interventions for TASC-II class C and D aorto-iliac obstructive lesions were performed at three Italian teaching hospitals. In 210 patients the intervention was performed for aortic and bilateral iliac involvement: an aorto-bifemoral bypass was performed in 82 patients (Group 1) while in the remaining 128 an endovascular recanalization with the kissing stent technique (Group 2). Early results in the two groups were compared with X2 test. Follow-up results were analyzed with Kaplan-Meyer curves and compared with log rank test Results: There were no differences between the two groups in terms of demographic data, comorbidities, risk factors for atherosclerosis, except for an higher percentage of females and of diabetic patients in group 2. Critical limb ischemia was present in 29 patients in group 1 (35.5%) and in 31 patients in group 2 (24%, p=0.07). Technical success in group 2 was 98.5%; two patients required immediate conversion to open surgery for iliac rupture. There was one perioperative death in group 1 (mortality rate 1.2%, p=0.2 in comparison with group 2). Four perioperative thromboses occurred, two in group 1 and two in group 2 (in one case requiring conversion to open surgical intervention) and no amputations at 30 days were recorded. Postoperative local and systemic complications occurred in 20 patients in group 1 (24%) and in 13 patients in group 2 (10% p=0.006). Mean duration of follow-up was 39 months (range 1-108 months). Survival rates at 6 years were 65% (SE 0.07) in group 1 and 82% (SE 0.05) in group 2 (p=0.07). At the same time interval, primary, assisted primary and secondary patency rates were similar; reintervention rates were 6% in group 1 (SE 0.05) and 11% in group 2 (SE 0.04; p=0.2). Conclusion: Endovascular repair of complex lesions of aorto-iliac district with the kissing stent-technique provided in this multicentric experience similar satisfactory early and late results to those obtained with open surgery, however with a lower rate of perioperative complications and a trend towards better long-term survival.