Abstract：
BACKGROUND: To describe the outcomes of the endovascular reconstruction of TASC C/D lesions involving the infrarenal aorta and aortic bifurcation with different techniques.
METHODS: This is an observational, retrospective, single-center study. In a 5-year period, we selected all the patients treated with an endovascular procedure for an aorto-iliac TASC C/D lesion involving the infrarenal aorta and/or the aortic bifurcation. Early (<30 days) outcomes were mortality, major amputation, and thrombosis. Late mid-term (1 and 3 years) outcomes were primary, assisted primary and secondary patency, limb salvage rate, and freedom from reintervention.
RESULTS: A total of 87 patients were treated during the index period. Kissing covered stent (cKS), covered reconstruction of aortic bifurcation (CERAB), and unimodular bifurcated AFX Unibody stent-graft (Bif-SG) implantation were performed in 35 (40.4%), 26 (29.8%), and 26 (29.8%) cases, respectively. Bif-SG group included 11 (11/26, 42.3%) patients treated for abdominal aortic aneurysm associated with the obstruction of the aortic bifurcation. Technical success was achieved in all cases and no ruptures or conversions to open surgery were recoded. Median follow-up age was 18 months (interquartile range [IQR], 8-34). Overall primary patency rate was 91.2% (95% confidence interval [CI]: 81.3-95.9) at 1 year and 83.5% (95% CI: 69.6-91.4) at 3 years. Assisted primary patency was 96.9% (95% CI: 87.8-99.2) at 1 and 3 years. Secondary patency was 97.8% (95% CI: 85.5-99.6) at 3 years. Limb salvage rate was 98.6% (95% CI: 90.1-99.7) at 1 and 3 years and, freedom from reintervention was 98.4% (95% CI: 88.9-99.7) at 1 year and 87% (95% CI: 66.1-95.4) at 3 years. Univariate analysis did not identify any factor affecting primary patency rate.
CONCLUSIONS: Endovascular reconstruction in severe aorto-iliac obstructions using advanced techniques offered promising mid-term patency rates and profiles of safety. The variety of reconstructive configurations allows surgeons to customize on patients\' anatomies the type of revascularization.
METHODS: This is an observational, retrospective, single-center study. In a 5-year period, we selected all the patients treated with an endovascular procedure for an aorto-iliac TASC C/D lesion involving the infrarenal aorta and/or the aortic bifurcation. Early (<30 days) outcomes were mortality, major amputation, and thrombosis. Late mid-term (1 and 3 years) outcomes were primary, assisted primary and secondary patency, limb salvage rate, and freedom from reintervention.
RESULTS: A total of 87 patients were treated during the index period. Kissing covered stent (cKS), covered reconstruction of aortic bifurcation (CERAB), and unimodular bifurcated AFX Unibody stent-graft (Bif-SG) implantation were performed in 35 (40.4%), 26 (29.8%), and 26 (29.8%) cases, respectively. Bif-SG group included 11 (11/26, 42.3%) patients treated for abdominal aortic aneurysm associated with the obstruction of the aortic bifurcation. Technical success was achieved in all cases and no ruptures or conversions to open surgery were recoded. Median follow-up age was 18 months (interquartile range [IQR], 8-34). Overall primary patency rate was 91.2% (95% confidence interval [CI]: 81.3-95.9) at 1 year and 83.5% (95% CI: 69.6-91.4) at 3 years. Assisted primary patency was 96.9% (95% CI: 87.8-99.2) at 1 and 3 years. Secondary patency was 97.8% (95% CI: 85.5-99.6) at 3 years. Limb salvage rate was 98.6% (95% CI: 90.1-99.7) at 1 and 3 years and, freedom from reintervention was 98.4% (95% CI: 88.9-99.7) at 1 year and 87% (95% CI: 66.1-95.4) at 3 years. Univariate analysis did not identify any factor affecting primary patency rate.
CONCLUSIONS: Endovascular reconstruction in severe aorto-iliac obstructions using advanced techniques offered promising mid-term patency rates and profiles of safety. The variety of reconstructive configurations allows surgeons to customize on patients\' anatomies the type of revascularization.
摘要：
目的：描述使用不同技术对累及肾下主动脉和主动脉分叉的TASCC/D病变进行血管内重建的结果。
方法：这是一个观察性的，回顾性,单中心研究。五年后,我们选择了所有经血管内手术治疗累及肾下主动脉和/或主动脉分叉的主动脉-髂动脉TASCC/D病变的患者.早期（<30天）结果为死亡率，严重截肢和血栓形成。晚期中期（1、3年）结局是主要的，辅助原发性和继发性通畅，保肢率和免于再干预。
结果：在检查期间共治疗了87例患者。接吻覆膜支架(cKS),在35例（40.4%）中进行了主动脉分叉（CERAB）的覆盖重建和单模态分叉AFX单体支架（Bif-SG）植入，26例（29.8%）和26例（29.8%），分别。Bif-SG组包括11例（11/26，42.3％）治疗与主动脉分叉阻塞相关的腹主动脉瘤的患者。在所有情况下都取得了技术成功，并且没有重新编码破裂或转换为开放手术。中位随访年龄为18个月(四分位距[IQR]，8-34).1年时的总原发性通畅率为91.2％（95％置信区间[CI]：81.3-95.9），3年时为83.5％（95％CI：69.6-91.4）。在1年和3年辅助的初级通畅率为96.9%(95%CI:87.8-99.2)。3年时，继发性通畅率为97.8%(95%CI:85.5-99.6)。1年和3年的肢体抢救率为98.6%(95%CI:90.1-99.7)，1年时无再干预率为98.4%(95%CI:88.9-99.7),3年时无再干预率为87%(95%CI:66.1-95.4).单因素分析未发现任何影响原发性通畅率的因素。
结论：使用先进技术的血管内重建在严重的主动脉-髂动脉阻塞中提供了有希望的中期通畅率和安全性。各种重建结构使外科医生可以根据患者的解剖结构定制血运重建的类型。
方法：这是一个观察性的，回顾性,单中心研究。五年后,我们选择了所有经血管内手术治疗累及肾下主动脉和/或主动脉分叉的主动脉-髂动脉TASCC/D病变的患者.早期（<30天）结果为死亡率，严重截肢和血栓形成。晚期中期（1、3年）结局是主要的，辅助原发性和继发性通畅，保肢率和免于再干预。
结果：在检查期间共治疗了87例患者。接吻覆膜支架(cKS),在35例（40.4%）中进行了主动脉分叉（CERAB）的覆盖重建和单模态分叉AFX单体支架（Bif-SG）植入，26例（29.8%）和26例（29.8%），分别。Bif-SG组包括11例（11/26，42.3％）治疗与主动脉分叉阻塞相关的腹主动脉瘤的患者。在所有情况下都取得了技术成功，并且没有重新编码破裂或转换为开放手术。中位随访年龄为18个月(四分位距[IQR]，8-34).1年时的总原发性通畅率为91.2％（95％置信区间[CI]：81.3-95.9），3年时为83.5％（95％CI：69.6-91.4）。在1年和3年辅助的初级通畅率为96.9%(95%CI:87.8-99.2)。3年时，继发性通畅率为97.8%(95%CI:85.5-99.6)。1年和3年的肢体抢救率为98.6%(95%CI:90.1-99.7)，1年时无再干预率为98.4%(95%CI:88.9-99.7),3年时无再干预率为87%(95%CI:66.1-95.4).单因素分析未发现任何影响原发性通畅率的因素。
结论：使用先进技术的血管内重建在严重的主动脉-髂动脉阻塞中提供了有希望的中期通畅率和安全性。各种重建结构使外科医生可以根据患者的解剖结构定制血运重建的类型。
