Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.003817
Jornal Vascular Brasileiro
Original Article

Factors associated with outcome of endovascular treatment of iliac occlusive disease: a single-center experience

Fatores associados com os desfechos clínicos do tratamento endovascular da doença oclusiva ilíaca: experiência de um único centro

Rafael de Athayde Soares, Marcelo Fernando Matielo, Francisco Cardoso Brochado-Neto, Marcus Vinícius Martins Cury, Veridiana Borges Costa, Maria Clara Pereira Sanjuan, Christiano Stchelkunoff Pecego, Roberto Sacilotto

Downloads: 0
Views: 315

Abstract

Background: Endovascular treatment (ET) of iliac occlusive disease (IOD) is well established in literature. Use of stents in IOD has achieved long-term limb salvage and patency rates similar to those of open surgery, with lower morbidity and mortality rates. Objectives: To report the long-term outcomes, particularly limb salvage and patency rates, of ET for IOD and the factors associated with these outcomes. Methods: This retrospective cohort study included patients with IOD who underwent iliac angioplasty (IA), between January 2009 and January 2015. Patients with critical limb ischemia or incapacitating claudication were included. Results: In total, 48 IA procedures were performed in 46 patients, with an initial technical success rate of 95.83%. Failure occurred in two patients, who were excluded, leaving 44 patients and 46 IA. The primary patency, secondary patency, limb salvage, and survival rates at 1200 days were 88%, 95.3%, 86.3%, and 69.9%, respectively. Univariate and multivariate Cox regression revealed that the primary patency rate was significantly worse in patients with TASC type C/D than in patients with TASC type A/B (p = 0.044). Analysis of factors associated with major amputation using Cox regression showed that the rate of limb loss was greater in patients with TASC type C/D (p = 0.043). Male gender was associated with reduced survival (p = 0.011). Conclusions: TASC type C/D was associated with a higher number of reinterventions and with worse limb loss and primary patency rates. Male gender was associated with a worse survival rate after ET of IOD.

Keywords

endovascular treatment; iliac occlusive disease; critical limb ischemia; incapacitating claudication; major amputation.

Resumo

Contexto: O tratamento endovascular da doença oclusiva ilíaca (DOI) é bem estabelecido. O uso de stents nas angioplastias ilíacas (AI) alcançou estimativas de salvamento de membro e perviedade similares às de cirurgias abertas, porém com menor morbimortalidade. Objetivos: Demonstrar os desfechos clínicos a longo prazo, principalmente as estimativas de salvamento de membro (ESM) e perviedade, do tratamento endovascular da DOI e os fatores associados. Método: Estudo de coorte retrospectiva e consecutiva incluindo pacientes com DOI e isquemia crítica ou claudicação limitante submetidos a AI entre janeiro de 2009 a janeiro de 2015. Resultados: Foram realizadas 48 AI em 46 pacientes, com uma taxa de sucesso técnico inicial de 95,83%. Ocorreu falha técnica em dois pacientes, os quais foram excluídos da análise, restando 44 pacientes e 46 AI. As estimativas de perviedade primária, perviedade secundária, ESM e sobrevida aos 1.200 dias foram de 88%, 95,3%, 86,3% e 69,9%, respectivamente. A regressão de Cox univariada e multivariada revelou que a perviedade primária foi pior em pacientes com classificação TASC C/D do que em pacientes TASC A/B (p = 0,044). Quando analisamos os fatores associados à amputação maior, verificou-se que lesões TASC tipo C/D (p = 0,043) apresentaram piores resultados. O sexo masculino foi associado com sobrevida reduzida (p = 0,011). Conclusões: Classificação TASC tipo C/D foi associada a um maior número de reintervenções, maior perda de membro e piores estimativas de perviedade primária. O sexo masculino foi associado a uma pior sobrevida.

Palavras-chave

tratamento endovascular; doença oclusiva líaca; isquemia crítica; claudicação limitante; amputação maior.

References

1. Galaria II, Davies MG. Percutaneous transluminal revascularization for iliac occlusive disease: long-term outcomes in Trans-Atlantic Inter-Society Consensus A and B lesions. Ann Vasc Surg. 2005;19(3):352-60. http://dx.doi.org/10.1007/s10016-005-0010-8. PMid:15818461.

2. Schürmann K, Mahnken A, Meyer J, et al. Long-term results 10 years after iliac arterial stent placement. Radiology. 2002;224(3):731-8. http://dx.doi.org/10.1148/radiol.2242011101. PMid:12202707.

3. Indes JE, Pfaff MJ, Farrokhyar F, et al. Clinical outcomes of 5358 patients undergoing direct open bypass or endovascular treatment for aortoiliac occlusive disease: a systematic review and meta-analysis. J Endovasc Ther. 2013;20(4):443-55. http://dx.doi.org/10.1583/13-4242.1. PMid:23914850.

4. Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol. 2007;50(17):e159-241. http://dx.doi.org/10.1016/j.jacc.2007.09.003. PMid:17950140.

5. Norgren L, Hiatt W, Dormandy J, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33(Suppl 1):S5-75. http://dx.doi.org/10.1016/j.ejvs.2006.09.024. PMid:17140820.

6. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45(1):S5-67. https://doi.org/10.1016/j.jvs.2006.12.037. PMid:17223489.

7. Kudo T, Chandra FA, Ahn SS. Long-term outcomes and predictors of iliac angioplasty with selective stenting. J Vasc Surg. 2005;42(3):466-75. http://dx.doi.org/10.1016/j.jvs.2005.05.002. PMid:16171589.

8. Kavaliauskienė Z, Benetis R, Inčiūra D, Aleksynas N, Kaupas RS, Antuševas A. Factors affecting primary patency of stenting for TransAtlantic Inter-Society (TASC II) type B, C, and D iliac occlusive disease. Medicina (Kaunas). 2014;50(5):287-94. http://dx.doi.org/10.1016/j.medici.2014.10.003. PMid:25488165.

9. Timaran CH, Prault TL, Stevens SL, Freeman MB, Goldman MH. Iliac artery stenting versus surgical reconstruction for TASC (Transatlantic Inter-Society Consensus) type B and C iliac lesions. J Vasc Surg. 2003;38(2):272-8. http://dx.doi.org/10.1016/S0741-5214(03)00411-7. PMid:12891108.

10. Kasemi H, Marino M, Dionisi CP, Di Angelo CL, Fadda GF. Sevenyear approach evolution of the aortoiliac occlusive disease endovascular treatment. Ann Vasc Surg. 2016;30:277-85. http://dx.doi.org/10.1016/j.avsg.2015.07.016. PMid:26370748.

11. Jongkind V, Akkersdijk GJ, Yeung KK, Wisselink W. A systematic review of endovascular treatment of extensive aortoiliac occlusive disease. J Vasc Surg. 2010;52(5):1376-83. http://dx.doi.org/10.1016/j.jvs.2010.04.080. PMid:20598474.

12. Ye W, Liu CW, Ricco JB, Mani K, Zeng R, Jiang J. Early and late outcomes of percutaneous treatment of Transatlantic Inter-Society Consensus class C and D aorto-iliac lesions. J Vasc Surg. 2011;53(6):1728-37. http://dx.doi.org/10.1016/j.jvs.2011.02.005. PMid:21609804.

13. Danczyk RC, Mitchell EL, Burk C, et al. Comparing patient outcomes between multiple ipsilateral iliac artery stents and isolated iliac artery stents. J Vasc Surg. 2012;55(6):1637-46, Discussion 1646. http://dx.doi.org/10.1016/j.jvs.2011.12.048. PMid:22360919.

14. Kudo T, Chandra FA, Ahn SS. The effectiveness of percutaneous transluminal angioplasty for the treatment of critical limb ischemia: A 10-year experience. J Vasc Surg. 2005;41(3):423-46.e5. http://dx.doi.org/10.1016/j.jvs.2004.11.041. PMid:15838475.

15. Mwipatayi BP, Sharma S, Daneshmand A, et al. Durability of the balloon-expandable covered versus bare-metal stents in the Covered versus Balloon Expandable Stent Trial (COBEST) for the treatment of aortoiliac occlusive disease. J Vasc Surg. 2016;64(1):83-94.e1. http://dx.doi.org/10.1016/j.jvs.2016.02.064. PMid:27131926.

5cd2c8fc0e88259742632f8f jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections