Comparative outcomes of aortobifemoral bypass with or without previous endovascular kissing stenting of the aortoiliac bifurcation

Sandro Lepidi; Davide Mastrorilli; Michele Antonello; Andrea Kahlberg; Paolo Frigatti; Gabriele Piffaretti; Stefano Bonardelli; Mauro Gargiulo; Gian Franco Veraldi; Reinhold Perkmann; Nicola Troisi; Santi Trimarchi; Raffaello Bellosta; Mario D'Oria; Collaborative Study Group

doi:10.1016/j.jvs.2024.03.027

Comparative outcomes of aortobifemoral bypass with or without previous endovascular kissing stenting of the aortoiliac bifurcation

J Vasc Surg. 2024 Mar 25:S0741-5214(24)00514-7. doi: 10.1016/j.jvs.2024.03.027. Online ahead of print.

Authors

Affiliations

¹ Division of Vascular and Endovascular Surgery, Department of Surgical Medical and Health Sciences, University of Trieste, Trieste, Italy. Electronic address: slepidi@units.it.
² Vascular Surgery, Integrated University Teaching Hospital, University of Verona School of Medicine, Verona, Italy.
³ Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, School of Medicine, Padova University, Padova, Italy.
⁴ Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy.
⁵ Vascular Surgery Unit, Department of Surgery, Hospital and University of Udine, Udine, Italy.
⁶ Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, ASST Settelaghi Universitary Teaching Hospital, Varese, Italy.
⁷ Division of Vascular Surgery, Department of Clinical and Experimental Sciences, University of Brescia School of Medicine, ASST Spedali Civili of Brescia, Brescia, Italy.
⁸ Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna School of Medicine, Policlinico S. Orsola and Ospedale Maggiore, Bologna, Italy.
⁹ Department of Vascular and Thoracic Surgery, Regional Hospital Bolzano, Bolzano, Italy.
¹⁰ Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
¹¹ Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
¹² Vascular Surgery - Department of Cardiovascular Surgery, Fondazione Poliambulanza, Brescia, Italy.
¹³ Division of Vascular and Endovascular Surgery, Department of Surgical Medical and Health Sciences, University of Trieste, Trieste, Italy.

PMID: 38537877
DOI: 10.1016/j.jvs.2024.03.027

Abstract

Objective: The aim of this multicenter national study was to compare the outcomes of primary open surgery by aorto-bifemoral bypass (ABFB) with those performed after a failed endovascular treatment (EVT) by kissing stent technique for complex aortoiliac occlusive disease (AIOD) lesions (TransAtlantic Inter-Society Consensus [TASC] II C and D).

Methods: All consecutive ABFB cases carried out at 12 vascular surgery centers between 2016 and 2021 were retrospectively collected and analyzed. Data included patients' baseline demographics and clinical characteristics, procedural details, perioperative outcomes, and follow-up results (survival, patency, amputation). The study cohort was divided into two groups based on indications for ABFB: primary treatment vs secondary treatment after EVT failure.

Results: Overall, 329 patients underwent ABFB during the study period (71% males; mean age, 64 years), of which 285 were primary treatment and 44 were after prior EVT. At baseline, no significant differences were found between study groups in demographics and clinical characteristics. TASC C and D lesions were similarly represented in the study groups (TASC C: 22% vs 78%; TASC D: 16% vs 84%). No major differences were found between study groups in terms of procedural details, early mortality, and perioperative complications. At 5 years, primary patency rates were significantly higher for primary ABFB (88%; 95% confidence interval [CI], 93.2%-84%) as compared with ABFB after prior EVT (69%; 95% CI 84.9%-55%; log rank P value < .001); however, the 5-year rates of secondary patency (100% vs 95%; 95% CI, 100%-86%) and limb salvage (97%; 95% CI, 99%-96 vs 97%; 95% CI, 100%-94%) were similar between study groups.

Conclusions: Surgical treatment of TASC C/D AIOD with ABFB seems to be equally safe and effective when performed after prior EVT, although primary ABFB seemed to have higher primary patency rates. Despite the need for more frequent reinterventions, secondary patency and limb salvage rates were similar. However, future large prospective trials are required to confirm these findings.

Keywords: Aorto-bifemoral bypass; Aortoiliac disease; Kissing stent; Multicenter.