Division of Vascular and Endovascular Surgery, Department of Surgical Medical and Health Sciences, University of Trieste, Trieste, Italy.
Vascular Surgery, Integrated University Teaching Hospital, University of Verona School of Medicine, Verona, Italy.
J Vasc Surg. 2024 Aug;80(2):451-458.e1. doi: 10.1016/j.jvs.2024.03.027. Epub 2024 Mar 25.
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).
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.
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.
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.
本多中心全国性研究旨在比较经主动脉-股动脉旁路移植术（ABFB）治疗的原发性开放手术与经吻合法支架技术治疗失败后的治疗效果（TransAtlantic Inter-Society Consensus [TASC] II C 和 D）用于治疗复杂主髂动脉闭塞性疾病（AIOD）病变。
回顾性收集了 2016 年至 2021 年间在 12 个血管外科中心进行的所有连续 ABFB 病例，并进行了分析。数据包括患者的基线人口统计学和临床特征、手术细节、围手术期结果和随访结果（生存、通畅率、截肢）。根据 ABFB 的适应证，将研究队列分为两组：原发性治疗与 EVT 失败后的继发性治疗。
研究期间共 329 例患者接受 ABFB（71%为男性；平均年龄 64 岁），其中 285 例为原发性治疗，44 例为 EVT 失败后的治疗。在基线时，研究组之间在人口统计学和临床特征方面无显著差异。研究组中 TASC C 和 D 病变的比例相似（TASC C：22% vs 78%；TASC D：16% vs 84%）。两组在手术细节、早期死亡率和围手术期并发症方面无显著差异。5 年时，原发性通畅率在原发性 ABFB 中显著更高（88%；95%置信区间[CI]：93.2%-84%），而在 EVT 失败后的 ABFB 中则较低（69%；95%CI：84.9%-55%；对数秩 P 值<.001）；然而，两组间的继发性通畅率（100% vs 95%；95%CI：100%-86%）和肢体存活率（97%；95%CI：99%-96% vs 97%；95%CI：100%-94%）相似。
当 TASC C/D AIOD 病变经 EVT 治疗失败后，行 ABFB 手术治疗似乎同样安全有效，尽管原发性 ABFB 似乎具有更高的原发性通畅率。尽管需要更频繁的再介入，但继发性通畅率和肢体存活率相似。然而，需要进行更大规模的前瞻性试验来证实这些发现。
