Two-year results of stenting vs hybrid operation for multilevel lesions of iliac and femoropopliteal arteries

• Osipova O.S.
• Cheban A.V.
• Gostev A.A.
• Ignatenko P.V.
• Karpenko A.A.

Abstract

Background. Choosing a revascularization method for multilevel lesions of the iliofemoral arteries is a difficult task.

Objective. The aim of this study was to compare the efficacy of a one-stage endovascular treatment for multilevel lesions of the iliac and femoropopliteal arteries versus a hybrid procedure (iliac artery stenting and femoropopliteal bypass).

Patients and methods. We conducted a retro-prospective study including patients with femoropopliteal TASC II C, D and ipsilateral iliac artery lesions. Patients in group 1 (MET – multilevel endovascular treatment) received stenting of the iliac and femoropopliteal arteries. Group 2 (Hybrid) patients were subjected to iliac artery stenting and femoropopliteal bypass. Propensity score matching was used to match the comparison groups for baseline characteristics. The data on the outcomes of surgical intervention were collected prospectively through face-to-face or remote contact with the patient.

Results. A total of 212 patients were enrolled into the study. Of these, 14 were excluded. After propensity score matching, 79 patients were assigned to the MET group and 83 patients to the Hybrid group. The two-year follow-up was completed by 62 patients from the MET group and 71 patients from the Hybrid group. The mean length of the stented femoropopliteal artery in the MET group was 185.6±67.2 mm. The mean length of the stented iliac arteries amounted to 71.3±33.5 mm and 75.6±29.3 mm (p=0.07) in the MET and Hybrid groups, respectively. A femoropopliteal bypass was performed with a prosthetic graft in 57 (68.7%) patients and an autologous vein was used in 26 (31.3%) cases. At 1 year, the primary and secondary patency for the MET group and Hybrid group was 69.6% versus 79.5% (p=0.10) and 83.5% versus 89.1% (p=0.20), respectively. The estimated hazard ratio for primary patency for MET versus Hybrid was 0.64 (95% CI 0.34–1.20), with the upper non-inferiority bound set at 1.6 corresponding to a 10% additive noninferiority margin for probabilities. The 2-year primary patency was 35.5% in the MET group and 54.9% in the Hybrid group (p=0.01). The 2-year secondary patency in the groups did not differ (61.3% and 70.4%, p=0.17). Target lesion revascularization accounted for 15.2% and 7.2% (p=0.08) in the MET and Hybrid groups, respectively. The primary sustained clinical improvement was 73.4% and 79.5% (p=0.23) in the MET and Hybrid groups, respectively. Clinical deterioration at 1 year was 12% in the Hybrid group versus 3.8% in the MET group (p=0.04), at 2 years of follow-up 29.5% and 14.5% (p=0.03), respectively. 1-year limb salvage in the MET and Hybrid groups was 100% and 92.8% (p=0.02), respectively. 2-year limb salvage was 96.82% and 84.5% (p=0.01) in the MET and Hybrid groups, respectively. 2-year survival in the MET and Hybrid groups was 100% and 95.7%, respectively.

Conclusion. Hybrid surgery for ilio-femoropopliteal lesions showed better 2-year primary patency than multilevel stenting. However, in the MET group, there was a higher rate of limb salvage and a lower rate of clinical deterioration at 1 and 2 years of follow-up. The rate of clinical improvement was comparable in both groups.

Funding. The study had no financial support.

Conflict of interest. The authors declare no conflicts of interest.

Authors’ contribution. Study conception and design – Karpenko A.A., Osipova O.S., Cheban A.V., Ignatenko P.V.; data collection and handling – Osipova O.S., Cheban A.V., Gostev A.A.; statistical processing – Osipova O.S., Gostev A.A.; draft manuscript preparation – Osipova O.S., Cheban A.V.; manuscript revision – Ignatenko P.V., Karpenko A.A.

For citation: Osipova O.S., Cheban A.V., Gostev A.A., Ignatenko P.V., Karpenko A.A. Two-year results of stenting vs hybrid operation for multilevel lesions of iliac and femoropopliteal arteries. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (1): 62–72. DOI: https://doi.org/10.33029/1027-6661-2024-30-1-62-72

Keywords:hybrid surgery; femoropopliteal bypass; iliac artery stenting; multilevel endovascular treatment