Outcomes of unibody endoprosthesis for treatment of aortic aneurysmal pathology and aortoiliac occlusive disease.

Abstract

ObjectiveUnibody Endoprosthesis (UBE) is a newer treatment modality for abdominal aortic pathology (AAP) and has increasingly been utilized for aortoiliac occlusive disease (AIOD). We report outcomes of patients undergoing UBE for AAP and AIOD.MethodsPatients (2016-2021) undergoing UBE were identified retrospectively at an academic institution. AAP included aneurysm/pseudoaneurysm/PAU. Chi-square and Kaplan-Meier analysis were used to evaluate outcomes by group.Results90 patients undergoing UBE were included with 39 patients undergoing AAP (43%) and AIOD treatment in 51 (57%). AAP patients were older (72.9 vs 62.5 years; p = .01), with a lower prevalence of female patients treated than AIOD (36% vs 57%; p = .04), diabetes (23% vs 45%; p = .03) and current smokers (46% vs 69%; p = .03). There were significant differences in arterial diameters with AAP patients exhibiting larger minimum aortic diameter (19 mm vs 15 mm; p < .0001), iliac (12.5 mm vs 9.8 mm; p < .0001), femoral (9 mm vs 6.9 mm; p < .0001), SFA (6.8 mm vs 5.2 mm; p < .0001) and profunda femoris (6 mm vs 4.9 mm; p = .002). Shorter surgery duration was seen with AAP than AIOD patients (135 min vs 194 min; p = .001). There were six major amputations in the overall cohort with two BKA and four AKA. There were no significant differences in unadjusted 30-day outcomes or mid-term outcomes between groups at a mean follow-up period of 20 months. Reinterventions over the follow-up period occurred in 9 limbs (5%) in the overall cohort with no significant associations between demographic or anatomic variables identified. Subgroup analysis of the whole cohort by sex revealed that female patients exhibited smaller minimum aortic diameter (14.9 mm vs 18.6 mm; p < .0001), common iliac (9.3 mm vs 12.5 mm; p < .0001), femoral (6.9 mm vs 8.7; p < .0001), SFA (5.2 mm vs 6.6 mm; p < .0001) and profunda femoris (4.9 mm vs 5.9 mm; p = .0006). Logistic regression analysis revealed an independent association between minimum aortic diameter (OR 1.61; 95% CI 1.0-2.4) and surgery length (OR 1.02; 95% CI 1-1.03) and overall mortality. Kaplan-Meier estimated survival at 36 months was 94% for AIOD and 84% for AAP (p = .23). At 36 months, primary patency was 78% for AIOD versus 100% for AAP (p = .002), primary-assisted patency was 94% for AIOD versus 100% for AAP (p = .12) and secondary patency for AIOD was 82% versus 100% for AAP (p = .008).ConclusionsUBE can be safely and effectively used for treating aortic aneurysmal pathology as well as aortoiliac occlusive disease in selected patients. Despite the differing pathologies, outcomes are similar with a low reintervention rate and excellent mid-term patency of the intervention. Interestingly, an independent association between mortality and small minimum aortic diameter was seen, further reinforcing AIOD as a marker for overall mortality when compared with aneurysm patients.