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Italian Journal of Vascular and Endovascular Surgery 2021 December;28(4):113-9

DOI: 10.23736/S1824-4777.21.01521-7


language: English

Endovascular and hybrid revascularization in TASC C and D lesions of aortoiliac disease: a monocentric retrospective study

Gustavo IACONO 1 , Alice CAMAGNI 2, Francesco GIACCHI 1, Elisa PACIARONI 1, Federica MARCHETTI 1, Simone TURCI 1, Filippo MAIOLI 1, Giorgio U. TURICCHIA 1

1 Unit of Vascular and Endovascular Surgery, M. Bufalini Hospital, AUSL della Romagna, Cesena, Forlì-Cesena, Italy; 2 Unit of Vascular and Endovascular Surgery, University of Ferrara, Ferrara, Italy

BACKGROUND: Aim of this study was to evaluate early and long-term outcomes of endovascular and hybrid aortoiliac revascularization for TASC C and D lesions. Primary endpoints are: technical success, clinical success and 30-day survival. Secondary endpoints are primary patency together with limb salvage.
METHODS: Between February 2014 and June 2019, 43 patients with symptomatic TASC C and D aortoiliac and femoral occlusive disease were treated with elective hybrid (HVP) or totally endovascular (EVP) revascularization.
RESULTS: Twenty (46.5%) patients underwent a totally endovascular procedure while 23 (53.5%) were treated via HVP. Twenty-nine patients (67%) presented with TASC D lesions. Rutherford Classification was 4-5-6 in 23 patients (54%). Femoral endarterectomy was performed in all HVP. Median procedure time was 175 minutes and was significantly higher in TASC D group (P=0.015); median in-hospital stay was 3 days; no significant differences were revealed between TASC C and D groups. Rutherford Classification stage 5-6 was statistically associated with a longer hospitalization and re-intervention rate. HVP presented compared to EVP longer in-hospital length of stay (P=0.0001), more late complications (P=0.007) and were more likely to undergo reintervention (P=0.02). Clinical and technical success was registered in all patients. No perioperative mortality was recorded. All the patients who presented complications belonged to the HVP group. Overall primary patency rate was 84% at 2 years and 73% at 5 years. Primary patency in the EVP was higher. Reintervention was necessary for five symptomatic patients. Limb salvage was 100% during the follow-up period.
CONCLUSIONS: This study demonstrates that the outcomes of EVP for TASC C and D aortoiliac lesions were acceptable also in high-risk patients. The results were worse in TASC D lesions and Rutherford 5-6. The rate of late reintervention due to failure is low and only in the hybrid procedure group.

KEY WORDS: Blood vessels; Endovascular procedures; Ischemia

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