Grimme F A B, Goverde P A, Van Oostayen J A, Zeebregts C J, Reijnen M M P J
Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
J Cardiovasc Surg (Torino). 2012 Jun;53(3):279-89.
Bare metal stents have improved results of endovascular treatment of aortoiliac occlusive disease. Polytetrafluoroethylene covered stents may further improve patency rates by preventing tissue ingrowth, and might reduce complications. This study was conducted to assess possible assets or liabilities of covered stents used for aortoiliac occlusive disease and to conduct a comparison with bare metal stents.
A review was performed of literature published until March 2012 for infrarenal aortic lesions, iliac lesions and complex aortoiliac lesions. Outcomes were technical success, patency rates, clinical success and complication rates. Results were addressed to the three anatomic regions: the infrarenal aorta, the aortoiliac bifurcation and iliac arteries.
A total of 51 articles were included in the study. Overall technical success varied between 73% and 100%. Randomized data have proven the superiority of covered stents in extensive iliac occlusive lesions. Case series of patients with iliac occlusive disease demonstrated a 1-year primary patency of bare metal stents between 76% and 100% with a 5-year primary patency rate of 63%-83%. One-year primary patency of covered stents varied between 70% and 100%, while no long term patency rates with covered stents have been reported so far. Reliable comparisons between groups cannot be made due to variances in patient and lesion characteristics. Covered stents seem to improve results of kissing stents and are related to excellent results in isolated aortic lesions. No difference in complication rate between bare metal and covered stents have been described, to date.
Covered stents improve results of endovascular treatment of extensive iliac occlusive lesions and are related to excellent results in isolated aortic lesions. They may provide a valid alternative for surgery in patients with extensive aortoiliac disease.
裸金属支架已改善了主髂动脉闭塞性疾病的血管内治疗效果。聚四氟乙烯覆膜支架可能通过防止组织向内生长进一步提高通畅率，并可能减少并发症。本研究旨在评估用于主髂动脉闭塞性疾病的覆膜支架的潜在优势或劣势，并与裸金属支架进行比较。
对截至2012年3月发表的有关肾下腹主动脉病变、髂动脉病变和复杂主髂动脉病变的文献进行综述。结果指标包括技术成功率、通畅率、临床成功率和并发症发生率。结果针对三个解剖区域进行阐述：肾下腹主动脉、主髂动脉分叉处和髂动脉。
本研究共纳入51篇文章。总体技术成功率在73%至100%之间。随机数据已证明覆膜支架在广泛髂动脉闭塞性病变中的优越性。髂动脉闭塞性疾病患者的病例系列显示，裸金属支架的1年原发性通畅率在76%至100%之间，5年原发性通畅率为63% - 83%。覆膜支架的1年原发性通畅率在70%至100%之间，而目前尚未有覆膜支架的长期通畅率报道。由于患者和病变特征存在差异，无法在组间进行可靠比较。覆膜支架似乎可改善对吻支架的效果，且在孤立性主动脉病变中效果优异。迄今为止，尚未描述裸金属支架和覆膜支架在并发症发生率上的差异。
覆膜支架可改善广泛髂动脉闭塞性病变的血管内治疗效果，且在孤立性主动脉病变中效果优异。它们可能为患有广泛主髂动脉疾病的患者提供一种有效的手术替代方案。
