The effect of the stented iliac lesions TASC-II C, D on the femoropopliteal bypass patency: Propensity score-matched observational study

• Published in: Vascular medicine (London, England) Vol. 27; no. 3; pp. 230 - 238
• Main Authors: Osipova, Olesia, Cheban, Alexey, Ignatenko, Pavel, Ruzankin, Pavel, Prokopenko, Evgeny, Karpenko, Andrey
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.06.2022; Sage Publications Ltd
• Subjects: Amputation; Arteries; Complexity; Femoral Artery - diagnostic imaging; Femoral Artery - surgery; Humans; Implants; Inflow; Ischemia; Lesions; Morbidity; Observational studies; Patients; Popliteal Artery - diagnostic imaging; Popliteal Artery - surgery; Propensity Score; Retrospective Studies; Risk Factors; Stents; Treatment Outcome; Upper bounds; Vascular Patency; hybrid surgery; femoropopliteal bypass; propensity score methods; iliac artery stenting; non-inferiority trial
• ISSN: 1358-863X; 1477-0377; 1477-0377
• DOI: 10.1177/1358863X211021165

Introduction Concurrent stenting of complex iliac lesions during infrainguinal bypasses can increase the complexity of a case and impact outcomes. Objective Our aim was to evaluate the effect of inflow stenting of TASC-II C, D iliac lesions on femoropopliteal bypass patency. Methods A retrospective observational cohort study of patients who underwent femoropopliteal bypass with TASC-II C, D iliac artery stenting (hybrid group) or without inflow lesions (non-hybrid group) was conducted. After propensity score matching, 120 patients were included in the non-hybrid group and 60 patients in the hybrid one. The median follow-up was 432 (193; 1313) days in the hybrid group and 472 (196; 1376) days in the non-hybrid group (p = 0.94). Results No significant differences were found between the groups in 30-day morbidity and serious adverse events. At 3 years, primary and secondary bypass patency for the hybrid group and non-hybrid group were 62.2% versus 59.9% (p = 0.36) and 63.7% versus 64.3% (p = 0.077), respectively. The primary patency of the iliac stents in patients of the hybrid group was 95% at 3 years. The estimated hazard ratio for primary patency for hybrid versus non-hybrid was 0.77, with 90% CI: 0.50–1.21; the noninferiority upper bound being 1.31, which corresponds to a 10% additive noninferiority margin for probabilities. The 3 years of freedom from amputation in patients with chronic limb-threatening ischemia was 94.1% and 75.0% in the hybrid and non-hybrid groups, respectively (p = 0.09). Conclusion The outcomes of the femoropopliteal bypass in hybrid surgery supplemented with stenting of TASC-II C, D iliac lesions was similar to femoropopliteal bypass with intact inflow arteries.