Endovascular reconstruction of the aortoiliac bifurcation with kissingstents: factors affecting patency and long-term results

Introduction: This research is focused on the outcome of endovascular treatment of peripheral occlusive aortoiliacal disease with kissingstents and the factors that influence patency. POAD has traditionally been treated with bypass surgery. Since the introduction of endovascular reconstruction with kissingstents in 1991 this treatment is under discussion. The widely accepted TASC II guidelines recommend endovascular therapy for TASC type A lesions and surgery for type D lesions. Purpose and Hypothesis: Evaluation of kissingstent therapy in Medisch Spectrum Twente. We expect similar patency rates than earlier studies. Possible predictors for reduced patency are severe chronic limb ischemia, TASC lesion type C and D, and crossing of the stents in the distal aorta. Material and Methods: This retrospective cohort study included all patients who received kissingstents in Medisch Spectrum Twente between 1995 and 2011. A database is compiled based on patient characteristics, lesion morphology, procedure and follow-up details. Patency rates were calculated with Kaplan-Meier analysis. Factors affecting the patency rates were determined with Cox multivariate analysis. Results: The search identified 215 patients (63% men, mean 61 years old). The success rate of the procedure is 99.5%. Complications occurred in 6.8% of the patients. The mean follow-up period was 45 months. Primary, primary assisted and secondary patency rates, respectively, were 97%, 97%, and 99% at one month; 75%, 86% and 91% at two years; 70%, 81% and 91% at five years; and 67%, 81% and 91% at ten years. In multivariate analysis younger age and previous aortoiliac treatment were predictors for reduced primary and primary assisted patency. Smoking, previous aortoiliac treatment and TASC lesion type C and D are predictors for reduced secondary patency. Discussion: Endovascular reconstruction of the aortoiliac bifurcation with kissingstents is feasible, safe and effective in all type of lesions, although occlusions occur more in TASC type C and D lesions. The patency rates are comparable with other studies focused on kissingstent treatment of POAD and those of vascular reconstruction. Younger age and previous aortoiliac treatment are predictors for reduced patency.