O-100 - DRUG ELUTING STENTS IN A TAILORED TREATMENT PROGRAM IMPROVE 5-YEAR OUTCOME IN TASC C AND D AORTO-ILIAC LESIONS.

TOPIC:
New vascular techniques and devices
AUTHORS:
Froio A. (Department of Medicine and Surgery, University of Milano-Bicocca ~ Monza ~ Italy) , Belloni A. (Department of Medicine and Surgery, University of Milano-Bicocca ~ Monza ~ Italy) , Segramora V. (Ospedale San Gerardo ~ Monza ~ Italy) , Deleo G. (Ospedale San Gerardo ~ Monza ~ Italy) , Ballabio F. (Ospedale San Gerardo ~ Monza ~ Italy) , Pasquadibisceglie S. (Ospedale San Gerardo ~ Monza ~ Italy) , De Ponti E. (Department of Medicine and Surgery, University of Milano-Bicocca ~ Monza ~ Italy)
Introduction:
Endovascular approach for patients with TransAtlantic Inter-Society (TASC II) type C and D aorto-iliac lesions is an alternative to surgery. The aim of the study was to assess the role of a tailored endovascular treatment according to aorto-iliac anatomy and the use of drug eluting stents at long term (5-year) follow-up in TASC C and D aorto-iliac lesions.
Methods:
We retrospectively analyzed all consecutive cases of TASC C and D aorto-iliac lesions treated by endovascular and hybrid approach at the San Gerardo Hospital. All patients had symptomatic peripheral artery disease (stage IIb, III and IV according to Fontaine classification) for aorto-iliac occlusive disease. Bare metal self-expandable, bare metal balloon-expandable, covered self-expandable, covered balloon-expandable and drug eluting stents were always available at the time of endovascular recanalization, allowed to set up a tailored treatment for each patient.
Results:
Eighty-two consecutive patients underwent 117 procedures, with a median age of 74 [IQR 67-79] years. Aorto-iliac lesions were classified as TASC C in 36.6% of patients and TASC D in 63.4%. General anesthesia was used in 79.3% of patients. Vascular access was percutaneous in 37.6% of limbs, surgical with associated endarterectomy in 47.6% of cases and brachial in 14.8%. The following bare metal stent configurations were used: only self expandable in 44.4%, only balloon-expandable in 17.9% and mixed self and balloon-expandable in 13.7% of cases. Covered and drug eluting stents were used in 14.5% and 13.7% of limbs, respectively. The technical success rate was 100%. The 30-day mortality was 0%. Three patients were re-operated for acute limb ischemia, with a 30-day secondary patency of 100%. Considering the follow-up, the survival was 79.6% at 5 years: advanced Fontaine classification stages, coronary artery disease, older age, previous stroke and the lack of statin therapy were predictors of death. At 5 years, primary patency, primary-assisted patency, secondary patency and amputation-free survival were 71.3%, 85.4%, 94.5% and 97.8%, respectively. The multivariate logistic regression model showed that the use of bare metal instead of drug eluting stents (p=0.026, OR=0.10, 95% CI 0.01-0.76), the type of common iliac disease (p=0.004, OR=10.00, 95% CI 2.04-50.00), and stent length greater than 160mm (p=0.024, OR=6.67, 95% CI 1.28-33.33) were independent predictors of reintervention at 5 years. Using these variables, a score was created ranging from 0 to 12 points. Twenty percent of patients had a score between 5 and 12, while the remaining 80% had a score lower than 4. The 5-year reintervention rate was 15.5 for patients with a score < =4 compared to 82.5% of those with the score ranging from 5 to 12 (p< 0.05).
Conclusion:
A tailored endovascular treatment for TASC C and D aorto-iliac lesions is associated with favorable short and long term outcome. We demonstrated for the first time that the use of drug eluting stents in iliac arteries is associated with an improved outcome. Further prospective studies are required to confirm these results.