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4 . 2025

Comparative analysis of endovascular and open surgical treatment of aortoiliac bifurcation lesions

Abstract

Objective. To compare endovascular treatment (kissing stenting, KS) with traditional open aortobifemoral bypass grafting (ABBG) in management of patients with lesions of the abdominal aorta bifurcation and iliac arteries.

Patients and methods. We performed a single-center analysis of patients subjected to endovascular treatment with bare-metal stents by means of kissing stenting or ABBG for TASCII C/D lesions of the aortoiliac segment (AIS) from 2012 to 2021. We assessed the parameters of the perioperative risk scale (American Society of Anesthesiologists, ASA and Society for Vascular Surgery, SVS), frequency of hospital complications, early 30-day mortality and long-tern patency. The obtained results were analyzed by means of the Kaplan–Meyer curves, with the Cox regression used to determine predictors influencing patency parameters.

Results. The study included 57 patients with KS and 86 patients with ABBG. The KS group had a higher perioperative risk: ASA (ACP=0.06), SVS (ACP=0.08) and less frequent lesions of the AIS (TASC D lesions 26.3% vs 46.5%, ACP=0.202). After propensity score matching, the study comprised a total of 80 patients (40 with KS and 40 with ABBG), thus forming well balanced groups in terms of demographic data, risk factors, lower limb ischemia degree, perioperative risk: ASA (ACP=0.006), SVS (ACP=0.003) and AIS lesion anatomy (TASC D – 40%, ACP=0.000).

36-month mortality amounted to 5% after KS vs 2.5% in the ABBG group. The length of hospital stay in the KS group was significantly shorter than in the ABBG group (3.9±1.6 days vs 9.1±1.9 days, p<0.001), as well as that of ICU stay (0 days vs 2.1±0.4 days, p=0.001). The rate of early postoperative complications was comparable (7.5% vs 15%, p=0.47). Three-year primary patency was similar between the KS and ABBG groups (87.5% vs 95%, p=0.24); multivariate analysis showed that critical limb ischemia and hemodynamically significant lesions of the efferent arteries were risk factors for developing restenosis/reocclusion (6.65 [1.29; 34.37], p=0.02 and 6.4 [0.72; 50.22], p=0.04, respectively).

Conclusion. Endovascular treatment of lesions of the aortic bifurcation and iliac arteries with bare-metal stents demonstrated primary patency comparable with that of ABBG over the 3-year follow-up period. The incidence of early postoperative complications was comparable. Thus, endovascular reconstruction of the aortoiliac segment for TASC C, D lesions by means of kissing stenting can be considered as an alternative to ABBG.

Keywords: endovascular treatment; bifurcation lesion; aortoiliac segment; aortic bifurcation; aortobifemoral bypass grafting; kissing stenting

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Saaya Sh.B., Gostev A.A., Karpenko A.A.; data collection and handling – Osipova O.S., Cheban A.V., Starodubtsev V.B.; statistical processing – Saaya Sh.B., Osipova O.S., Cheban A.V.; draft manuscript preparation – Valiev E.L., Ignatenko P.V., Karpenko A.A. Chernyavsky A.M.; manuscript revision – Saaya Sh.B., Gostev A.A., Karpenko A.A.

For citation: Saaya Sh.B., Gostev A.A., Osipova O.S., Cheban A.V., Starodubtsev V.B., Valiev E.L., Ignatenko P.V., Karpenko A.A. Chernyavsky A.M. Comparative analysis of endovascular and open surgical treatment of aortoiliac bifurcation lesions. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2025; 31 (4): 62–70. DOI: https://doi.org/10.33029/1027-6661-2025-31-4-62-70

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CHIEF EDITOR
CHIEF EDITOR
Yuri V. Belov
Academician of the Russian Academy of Sciences Doctor of Medical Sciences, Professor, President of the Russian Society of Angiologists and Vascular Surgeons

 

In accordance with the decision of the Presidium of the Russian Society of Angiologists and Vascular Surgeons, the journal "Angiology and Vascular Surgery" will be named after Academician A.V. Pokrovsky starting from No. 2/2022.

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