Outcomes of the safety and efficacy of covered stents versus bare-metal stents for Endovascular Treatment of Aortoiliac Occlusive Disease: A Single-Center Experience.

Abstract

Objectives: 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.

Methods: 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.

Results: 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).

Conclusions: 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.