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Early and mid-term outcomes of PTFE-covered stent versus bare metal stent in the primary treatment of severe iliac artery obstructive lesions.
Michele Piazza, M.D.1, Luca Milan, M.D.1, Paola Scrivere, M.D.1, Stefano Bonvini, M.D.1, Joseph J. Ricotta, Jr., M.D.2, Franco Grego, M.D.1, Michele Antonello, M.D.1.
1Vascular and Endovascular Surgery Clinic, Padova University., Padova, Italy, 2Vascular and Endovascular Surgery, NorthSide, Atlanta, GA, USA.
Objective: Objective of this study was to compare early and mid-term outcomes of PTFE-covered stent (CS) versus bare metal stent (BMS), in the primary treatment of severe TransAtlalntic InterSociety Consensus II (TASC) C and D iliac artery obstructive lesions.
Methods:Between January 2009 and July 2014, 134 patients underwent 177 iliac arteries stenting; CS was implanted in 91 iliac arteries (51%), while BMS in 86 (49%). All patients were prospectively enrolled in a dedicated database. Thirty-day outcomes, mid-term patency and limb salvage were compared; follow-up results were analyzed with Kaplan-Meier curves. Clinical presentation, lesion site, extension and laterality, were evaluated for their association with patency in the two groups using multiple logistic regressions.
Results: Overall, mean age was 69±9.27 with a Society for Vascular Surgery (SVS) comorbidity score of 0.89±0.55 with no differences after stratification by CS and BMS (p=0.7); iliac lesions were classified as TASC C (n=96; 54%) and D (n=81; 46%) with 89 being monolateral and 44 bilateral (67% vs 33%). Comparing CS and BMS, technical success was 99% in both groups (p=0.2); 30-day cumulative rate of surgical complications (4% vs 7%; p=0.51) mortality (0% vs 1.3%; p=0.34) and morbidity (3% vs 4.5%; p=0.63) were equivalent. At 18 months primary patency of CS vs BMS was similar (95% vs 92%; p=0.74) and was maintained after stratification by TASC C (97% vs 94%) and D (91% vs 89%); secondary patency was 97% vs 93% (p=0.91) and limb salvage was 99% and 98% (p=0.25) respectively. Multivariate analysis indicated that CS in long segment stenosis involving both common and external iliac artery was positive predictor of patency (OR, 2.8; 95% CI, 1.1-8.6; p=.03).
Conclusions: Overall the use of CS for severe iliac lesions has similar early and mid term outcomes compared to BMS. In a subcategory of TASC D lesions, with long segment severe stenosis of both common and external iliac artery, CS should be considered as primary line of treatment.
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