Outcomes of the Endovascular Treatment of Stenotic Lesions versus Chronic Total Occlusions in the Iliac Sector

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• 作者：Sergio Revuelta Suero ; ^{dr.revuelta@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Isaac Martí ; nez Ló ; pez ; Manuela Herná ; ndez Mateo ; Pablo Marqué ; s de Marino ; Iñ ; aki Cernuda Artero ; Maday Cabrero Ferná ; ndez ; Francisco Javier Serrano Hernando
• 刊名：Annals of Vascular Surgery
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：34
• 期：Complete
• 页码：157-163
• 全文大小：566 K

文摘

This study compares outcomes of the endovascular treatment (EVT) of iliac artery occlusive disease according to whether the treated lesion is a stenosis or a chronic total occlusion (CTO).

Methods

Patients undergoing EVT from 2003 to 2013 for iliac artery occlusive disease were identified and the lesions treated stratified into stenotic (Group 1, n = 375) or CTO (Group 2, n = 87). Patients were followed clinically and hemodynamically (thigh–brachial index, TBI). Comorbidities, procedural factors, and outcomes were compared between the 2 groups using Kaplan–Meier, Breslow, and Cox models.

Results

Four hundred sixty-two iliac endovascular procedures in 378 patients were included in a retrospective study. The 2 groups only differed in preprocedural TBI [0.77 (Group 1) vs. 0.67 (Group 2), P < 0.001], lesion length [39.7 mm (Group 1) vs. 49.9 mm (Group 2), P < 0.001], and the use of a covered stent [11.6% (Group 1) vs. 46.2% (Group 2), P < 0.001]. The technical success rate was higher in Group 1 (99.2% vs. 89.7%, P < 0.001). Five early occlusions were recorded in Group 1 and 3 in Group 2 (1.3% vs. 3.8%, P = 0.146). Median follow-up was 34 months (1–113). At 12 and 36 months, stenotic lesions showed better primary (P1) and secondary (P2) patency rates [P1 93.0% and 85.8% vs. 83.1% and 74.7%, hazard ratio (HR) 1.90 (1.15–3.14), P = 0.018; P2 97.8% and 96.8% vs. 93.0% and 87.4%, HR 2.86 (1.39–5.90), P = 0.007] and freedom from reintervention (FFR) rates [91.6% and 83.5% vs. 84.1% and 78.9%, HR 1.51 (0.90–2.53), P = 0.132]. In a multivariate analysis, CTO showed a worse P2 than stenotic lesions [HR 2.81 (1.17–6.76), P = 0.021], yet no differences emerged in P1 [HR 1.41 (0.76–2.63), P = 0.277] or FFR [HR 1.43 (0.79–2.57), P = 0.237]. A lower preprocedural TBI was correlated with a greater risk of EVT failure in terms of patency and FFR (P < 0.05). The use of a stent shorter than 40 mm emerged as a protective factor with an HR for P1 of 3.68 (1.53–8.87) (P = 0.004).

Conclusions

EVT for iliac artery disease offers good outcomes in terms of long-term patency, although improved results were observed here for the treatment of stenotic lesions over CTO. Procedures performed in patients with a lower TBI and the use of a stent >40 mm were related to a worse stent patency.