April 30, 2019
Italian Retrospective Review Compares Surgery to Endovascular Repair Using Covered Stents to Treat Complex Aortoiliac Disease
May 1, 2019 – Endovascular repair with balloon-expandable covered stents to treat complex aortoiliac lesions was shown to shorten hospital stay and has comparable outcomes to open surgery in low-risk male patients, according to findings from a study presented by Michele Antonello, MD, at the 2019 Charing Cross Symposium, held April 15–18 in London, United Kingdom.
Investigators for this single-center retrospective review found that patients with TransAtlantic Inter-Society Consensus (TASC) II class C or D aortoiliac lesions who underwent endovascular treatment spent less than one-third of the time in hospital as those who had open surgery at 30 days postprocedure. Additionally, primary patency rates for endovascular and surgical approaches were similar at 5 years for men, but worse for women.
As summarized in the Charing Cross Symposium announcement, the investigators reviewed the outcomes in 114 patients with a mean age of 61.4 years and TASC C/D lesions treated between 2008 and 2017. The study excluded patients with associated aortic aneurysm or lesions involving the entire infrarenal aorta.
At 30 days, the endovascular repair group spent a mean of 2.6 days in the hospital and 0.1 days in the intensive care unit. Patients in the surgery group spent a mean of 8.5 days in the hospital and 0.9 days in the intensive care unit. At 5 years, the primary patency rate was 81.4% for the endovascular repair group and 87.3% for the surgical group.
Additionally, in a subgroup of patients ≤ 60 years, the primary patency at 5 years for endovascular patients was 75% versus 84.7% for surgical patients. The only predictor of negative patency was female sex in the endovascular repair group.
Dr. Antonello concluded that in cases of severe aortoiliac obstructive lesions in low-risk, young male patients, endovascular repair can be considered to have comparable outcomes to the open surgery approach and shorten hospital stays. For female patients, however, open surgery repair remains the standard of treatment, stated the Charing Cross Symposium announcement.