Vascular Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China.
Vascular Surgery Center, Ji Shuitan Hospital, Beijing, PR China.
Ann Vasc Surg. 2023 Aug;94:239-245. doi: 10.1016/j.avsg.2023.02.011. Epub 2023 Mar 2.
We sought to investigate the midterm results of kissing self-expanding covered stents (SECSs) for the reconstruction of aortic bifurcation in complex aortoiliac occlusive disease.
Data of consecutive patients who had undergone endovascular treatment for aortoiliac occlusive disease were screened. Only patients with TransAtlantic Inter-Society Consensus (TASC) class C and D lesions treated by bilateral iliac kissing stents (KSs) were included. Midterm primary patency, risk factors, and limb salvage rates were analyzed. Follow-up results were analyzed using the Kaplan-Meier curves. Cox proportional hazards models were used to identify the predictors of primary patency.
A total of 48 patients (95.8% men; mean age, 65.3 ± 10.2 years) were treated with kissing SECSs. Of them, 17 patients had TASC-II class C lesions and 31 had class D lesions. There were 38 total occlusive lesions, with a mean occlusive lesion length of 108.2 ± 57.3 mm. The overall mean lesion length was 140.3 ± 60.5 mm, and the mean length of implanted stents in the aortoiliac arteries was 141.9 ± 59.9 mm. The mean diameter of the deployed SECSs was 7.8 ± 0.5 mm. The mean follow-up time was 36.5 ± 15.8 months, and the follow-up rate was 95.8%. At 36 months, the overall primary patency, assisted primary patency, secondary patency, and limb salvage rates were 92.2%, 95.7%, 97.8%, and 100%, respectively. Univariate Cox regression analysis revealed that stent diameter ≤7 mm (hazard ratio [HR]: 9.53; 95% confidence interval [CI] 1.56-57.94, P = 0.014) and severe calcification (HR: 12.66; 95% CI 2.04-78.45, P = 0.006) were significantly associated with restenosis. Multivariate analysis showed severe calcification to be the only significant determinant of restenosis (HR: 12.66; 95% CI 2.04-78.45, P = 0.006).
Kissing SECSs provide good midterm results for the treatment of aortoiliac occlusive disease. A stent diameter >7 mm is a potent protective factor against restenosis. Because severe calcification appears to be the only significant determinant of restenosis, patients with severe calcification require close follow-up.
本研究旨在探讨 Kissing 自膨式覆膜支架（SECSs）在治疗复杂主髂动脉闭塞性疾病中的中期疗效。
筛选了接受主髂动脉闭塞性疾病腔内治疗的连续患者的数据。仅纳入 TASC II 分级 C 和 D 病变且接受双侧髂内吻合法（KSs）治疗的患者。分析中期通畅率、危险因素和保肢率。采用 Kaplan-Meier 曲线分析随访结果。采用 Cox 比例风险模型识别通畅率的预测因素。
共 48 例（95.8%男性；平均年龄 65.3±10.2 岁）患者接受了 Kissing SECSs 治疗。其中 17 例为 TASC II 分级 C 病变，31 例为分级 D 病变。38 例为完全闭塞病变，闭塞病变平均长度为 108.2±57.3mm。总病变长度平均为 140.3±60.5mm，主髂动脉植入支架的平均长度为 141.9±59.9mm。展开的 SECS 平均直径为 7.8±0.5mm。平均随访时间为 36.5±15.8 个月，随访率为 95.8%。36 个月时，总通畅率、辅助通畅率、二级通畅率和保肢率分别为 92.2%、95.7%、97.8%和 100%。单因素 Cox 回归分析显示，支架直径≤7mm（风险比[HR]：9.53；95%置信区间[CI]：1.56-57.94，P=0.014）和严重钙化（HR：12.66；95%CI：2.04-78.45，P=0.006）与再狭窄显著相关。多因素分析显示，严重钙化是再狭窄的唯一显著决定因素（HR：12.66；95%CI：2.04-78.45，P=0.006）。
Kissing SECSs 为治疗主髂动脉闭塞性疾病提供了良好的中期结果。支架直径>7mm 是防止再狭窄的有力保护因素。由于严重钙化似乎是再狭窄的唯一显著决定因素，因此严重钙化的患者需要密切随访。
