Athayde Soares Rafael de, Lorenzoni Gabriel Souza, Pinheiro Victor Galvão, Peixoto Aleixo Flávio Augusto, Alves Duarte Teresa Cristina, Neto Valdeno Brito, Takamitsu Nakamura Edson, Sacilotto Roberto
Ann Vasc Surg. 2025 Sep 5. doi: 10.1016/j.avsg.2025.08.026.
The purpose of this paper was to compare the efficacy of covered stents (CSs) and bare metal stents (BMSs) in treating all types of aortoiliac occlusive disease (AIOD) and subsequently to analyze the risk factors associated with restenosis, limb salvage, and patency.
This prospective cohort study included consecutive patients with AIOD who underwent aortoiliac angioplasty, and two groups of patients were evaluated: patients with AIOD submitted to endovascular treatment with the use of covered stents and bare metal stents. Patients with critical limb ischemia or incapacitating claudication who underwent aortoiliac angioplasty during the index period were eligible for the study.
In total, 103 aortoiliac angioplasties were performed in 103 patients, with an initial technical success rate of 100%. Analyses were performed at 1800 days. Two groups of patients were evaluated: 33 patients (32%) submitted to endovascular treatment with covered stents and 70 patients (68%) with bare metal stents. The estimated primary patency rates at 1800 days were better for the covered stents group ( 91.7%) than the bare metal stents group (58.8%, p = 0.001). Moreover, the time freedom from reintervention rates at 1800 days were better for the covered stents group (90%) than the bare metal stents group (58.4%, p = 0.003). The limb salvage rates at 1800 days were 100% in the covered stents group and 85.3% in the bare metal stents group, p = 0.07. A Cox regression revealed that the primary patency rate was significantly worse in patients of the bare metal stents group (HR = 2,50, CI = 1.51-9.38, p = 0.019), conversely, concomitant common femoral endarterectomy was a protector factor for primary patency (HR = 0.906, CI = 0.022-0.754, p = 0.023). Moreover, arterial hypertension was associated with reduced survival rates at the Cox regression analysis (HR = 2.61, CI = 1.005-6.806, p = 0.049).
Based on the results of this study, we conclude that endovascular treatment with covered stents for AIOD has better outcomes regarding primary patency and freedom from reintervention rates than bare metal stents. Moreover, concomitant common femoral endarterectomy is a protective factor for better primary patency. Another important finding of this cohort is that arterial hypertension is associated with reduced survival rates.
本文旨在比较覆膜支架（CS）和裸金属支架（BMS）治疗各类主髂动脉闭塞性疾病（AIOD）的疗效，并分析与再狭窄、肢体挽救及通畅率相关的危险因素。
这项前瞻性队列研究纳入了连续接受主髂动脉血管成形术的AIOD患者，并对两组患者进行评估：使用覆膜支架和裸金属支架进行血管内治疗的AIOD患者。在索引期内接受主髂动脉血管成形术的严重肢体缺血或致残性间歇性跛行患者符合研究条件。
总共对103例患者进行了103次主髂动脉血管成形术，初始技术成功率为100%。在1800天时进行分析。评估了两组患者：33例（32%）接受覆膜支架血管内治疗的患者和70例（68%）接受裸金属支架治疗的患者。覆膜支架组在1800天时的估计原发性通畅率（91.7%）优于裸金属支架组（58.8%，p = 0.001）。此外，覆膜支架组在1800天时的无再次干预时间率（90%）优于裸金属支架组（58.4%，p = 0.003）。覆膜支架组在1800天时的肢体挽救率为100%，裸金属支架组为85.3%，p = 0.07。Cox回归显示，裸金属支架组患者的原发性通畅率显著更差（HR = 2.50，CI = 1.51 - 9.38，p = 0.019），相反，同期进行股总动脉内膜切除术是原发性通畅的保护因素（HR = 0.906，CI = 0.022 - 0.754，p = 0.023）。此外，在Cox回归分析中，动脉高血压与生存率降低相关（HR = 2.61，CI = 1.005 - 6.806，p = 0.049）。
基于本研究结果，我们得出结论，对于AIOD，覆膜支架血管内治疗在原发性通畅率和无再次干预率方面比裸金属支架有更好的结果。此外，同期进行股总动脉内膜切除术是实现更好原发性通畅的保护因素。该队列的另一项重要发现是动脉高血压与生存率降低相关。
