Smith Andrew H, Dash Siddhartha, Steenberge Sean, Quatromoni Jon G, Rowse Jarrad W, Caputo Francis J, Kirksey Levester, Graham Linda M, Lyden Sean P, Smolock Christopher J
Aortic Center and Heart Vascular and Thoracic Institute, Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA.
Vascular. 2024 Aug;32(4):804-810. doi: 10.1177/17085381221141737. Epub 2023 Feb 19.
Hypogastric coverage may be required for occlusive disease at the iliac arterial bifurcation. In this study, we sought to determine patency rates of common-external iliac artery (C-EIA) bare metal stents (BMS) spanning the hypogastric origin in patients with aortoiliac occlusive disease (AIOD). In addition, we sought to identify predictors of C-EIA BMS patency loss and major adverse limb events (MALE) in patients requiring hypogastric coverage. We hypothesized that worsening stenosis of the hypogastric origin would negatively influence C-EIA stent patency and freedom from MALE.
This is a single center, retrospective review of consecutive patients undergoing elective, endovascular treatment of aortoiliac disease (AIOD) between 2010 and 2018. Only patients with C-EIA BMS coverage of a patent IIA origin were included in the study. Hypogastric luminal diameter was determined from preoperative CT angiography. Analysis was performed using Kaplan-Meier survival analysis, univariable and multivariable logistic regression, and receiver operator characteristics (ROC).
There were 236 patients (318 limbs) who were included in the study. AIOD was TASC C/D in 236/318 (74.2%) of cases. C-EIA stent primary patency was 86.5% (95% confidence interval: 81.1, 91.9) at 2 years and 79.7% (72.8, 86.7) at 4 years. Freedom from ipsilateral MALE was 77.0% (71.1, 82.9) at 2 years and 68.7% (61.3, 76.2) at 4 years. Luminal diameter of the hypogastric origin was most strongly associated with loss of C-EIA BMS primary patency in multivariable analysis (hazard ratio: 0.81, = .02). Insulin-dependent diabetes, Rutherford's class IV or above, and stenosis of the hypogastric origin were significantly predictive of MALE in both univariable and multivariable analyses. In ROC analysis, luminal diameter of the hypogastric origin was superior to chance in prediction of C-EIA primary patency loss and MALE. Hypogastric diameter >4.5 mm had a negative predictive value of 0.94 for C-EIA primary patency loss and 0.83 for MALE.
Patency rates of C-EIA BMS are high. Hypogastric luminal diameter is an important and potentially modifiable predictor of C-EIA BMS patency and MALE in patients with AIOD.
髂总动脉分叉处闭塞性疾病可能需要覆盖下腹动脉。在本研究中，我们试图确定在腹主动脉-髂动脉闭塞性疾病（AIOD）患者中，跨越下腹动脉起始部的髂总动脉-股总动脉（C-EIA）裸金属支架（BMS）的通畅率。此外，我们试图确定在需要覆盖下腹动脉的患者中，C-EIA BMS通畅性丧失和主要不良肢体事件（MALE）的预测因素。我们假设下腹动脉起始部狭窄加重会对C-EIA支架通畅性和无MALE产生负面影响。
这是一项单中心回顾性研究，对2010年至2018年间接受择期血管内治疗腹主动脉-髂动脉疾病（AIOD）的连续患者进行分析。研究仅纳入C-EIA BMS覆盖通畅的髂内动脉起始部的患者。下腹动脉管腔直径通过术前CT血管造影确定。采用Kaplan-Meier生存分析、单变量和多变量逻辑回归以及受试者工作特征（ROC）分析。
共有236例患者（318条肢体）纳入研究。236/318（74.2%）的病例中AIOD为TASC C/D级。C-EIA支架2年时的初始通畅率为86.5%（95%置信区间：81.1，91.9），4年时为79.7%（72.8，86.7）。2年时同侧无MALE的比例为77.0%（71.1，82.9），4年时为68.7%（61.3，76.2）。多变量分析中，下腹动脉起始部的管腔直径与C-EIA BMS初始通畅性丧失的相关性最强（风险比：0.81，P =.02）。在单变量和多变量分析中，胰岛素依赖型糖尿病、卢瑟福分级IV级及以上以及下腹动脉起始部狭窄均是MALE的显著预测因素。在ROC分析中，下腹动脉起始部的管腔直径在预测C-EIA初始通畅性丧失和MALE方面优于随机概率。下腹动脉直径>4.5 mm对C-EIA初始通畅性丧失的阴性预测值为0.94，对MALE的阴性预测值为0.83。
C-EIA BMS的通畅率较高。下腹动脉管腔直径是AIOD患者中C-EIA BMS通畅性和MALE的重要且可能可改变的预测因素。
