1 Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.
2 Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, the Netherlands.
J Endovasc Ther. 2019 Feb;26(1):31-40. doi: 10.1177/1526602818810535. Epub 2018 Nov 30.
To evaluate short- and long-term technical and clinical outcomes after kissing stent treatment of aortoiliac occlusive disease (AIOD) based on an individual participant data (IPD) meta-analysis.
A search of the Scopus database identified 156 articles on KS treatment of AIOD; of these 22 met the inclusion criteria. Authors of 19 articles with contact information were approached to join an IPD consortium. Eight author groups responded and 5 provided anonymized data for merging into an IPD database. The number of included procedures was equal before and after 2005. The primary study outcome was the cumulative patency at 24 months. Secondary outcomes were patency at up to 60 months, complications, and changes in Rutherford category and ankle-brachial index. The predictive value of stent protrusion length, pre-/postdilation, stent type, and patient demographics on primary patency were examined with Cox proportional hazard modeling; outcomes are reported as the hazard ratio (HR). The Kaplan-Meier method was employed to estimate patency rates.
In total, 605 (40.9%) of 1480 patients presented in the literature were included in the IPD analysis. The indication for intervention was intermittent claudication in 84.2% and critical limb ischemia in 15.8%. Lesions were classified as TransAtlantic Inter-Society Consensus (TASC) A or B in 52.8% and TASC C and D in 47.2%. The overall primary patency estimate was 81% at 24 months. Primary patency significantly increased after 2005 (p=0.005). Cox regression analysis revealed only age as a significant predictor of sustained primary patency (HR 0.60, p<0.005). Any previous endovascular intervention (HR 2.52, p=0.02) was the main predictor for loss of secondary patency; history of cardiovascular disease (HR 0.27, p=0.04) was the main predictor of sustained secondary patency.
The kissing stent technique has a good safety profile and acceptable patency rates up to 2 years, even in TASC C and D lesions, supporting an endovascular-first approach for AIOD.
基于个体参与者数据（IPD）荟萃分析，评估吻合法治疗主髂动脉闭塞性疾病（AIOD）的短期和长期技术及临床结果。
在 Scopus 数据库中进行了一项搜索，以确定 156 篇关于 KS 治疗 AIOD 的文章；其中 22 篇符合纳入标准。联系了 19 篇有联系方式的文章的作者，邀请他们加入 IPD 合作组织。有 8 个作者组做出了回应，其中 5 个提供了匿名数据以合并到 IPD 数据库中。纳入手术的数量在 2005 年前后相等。主要研究结果是 24 个月时的累积通畅率。次要结果包括 60 个月时的通畅率、并发症以及 Rutherford 分类和踝肱指数的变化。采用 Cox 比例风险模型检查支架突出长度、预扩张/后扩张、支架类型和患者人口统计学特征对原发性通畅率的预测价值；结果以风险比（HR）表示。采用 Kaplan-Meier 方法估计通畅率。
共有 1480 例患者中的 605 例（40.9%）被纳入 IPD 分析。介入治疗的适应证为间歇性跛行占 84.2%，严重肢体缺血占 15.8%。病变按跨大西洋内科学会共识（TASC）分类为 A 或 B 级占 52.8%，C 和 D 级占 47.2%。24 个月时的总体主要通畅率估计为 81%。2005 年后，主要通畅率显著增加（p=0.005）。Cox 回归分析显示，只有年龄是持续性主要通畅率的显著预测因素（HR 0.60，p<0.005）。任何先前的血管内介入治疗（HR 2.52，p=0.02）是次要通畅丧失的主要预测因素；心血管疾病史（HR 0.27，p=0.04）是持续性次要通畅的主要预测因素。
吻合法技术具有良好的安全性和可接受的通畅率，在 TASC C 和 D 病变中可达 2 年，支持对 AIOD 采用血管内优先的治疗方法。
