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Management of Extensive Aorto-Iliac Disease: A Systematic Review and Meta-Analysis of 9319 Patients

  • Scientific Paper (other)
  • Arterial Interventions
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Abstract

Purpose

Despite advances in endovascular management of aorto-iliac occlusive disease (AIOD) including covered endovascular reconstruction of aortic bifurcation (CERAB) techniques, guidelines for management of symptomatic Trans-Atlantic Inter-Society Consensus (TASC II) type C/D lesions favour open surgical revascularisation. This meta-analysis investigates outcomes in patients with TASC II C/D lesions treated with open bypass procedures (OS), standard endovascular treatments (SEV) or CERAB.

Methods

Multiple databases (MEDLINE, EMBASE and the Cochrane database) were searched to identify studies reporting endovascular and open treatment of extensive AIOD. Studies were independently assessed. Outcomes reported included 30-day morbidity/mortality and patency rates.

Results

A total of 9319 patients undergoing intervention for extensive AIOD were identified from 66 studies. Median patient age was 64 years (n = 3204) for SEV, 58 years (n = 240) for CERAB and 59 years for OS (n = 5875). Pooled meta-analysis for 30-day morbidity in patients undergoing SEV, CERAB and OS was 9, 10 and 15%, respectively. Thirty-day mortality rate was 0.79, 0 and 3% in the SEV, CERAB and OS groups, respectively. In these groups, one-year primary and secondary patency was 90, 88, 96 and 96, 97, and 97% whilst three-year primary and secondary patency was 78, 82, 93 and 93, 97, 97% respectively. Five-year primary and secondary patency was 71 and 89% for SEV and 88 and 95% for OS, respectively. CERAB data were only available to 3 years.

Conclusions

This meta-analysis shows that thirty-day morbidity and mortality favours endovascular techniques. Primary patency remains better with OS in both early and midterms;; however, secondary patency is comparable in all groups. These findings suggest that SEV/CERAB may be considered as an alternative to OS in higher-risk patients.

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Abbreviations

AIOD:

Aorto-iliac occlusive disease

CERAB:

Covered endovascular reconstruction of aortic bifurcation

OS:

Open bypass surgery

NOS:

Newcastle–Ottawa score

SEV:

Standard endovascular treatment

TASC:

Trans-Atlantic Inter-Society Consensus

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Authors and Affiliations

  1. Department of Vascular Surgery, Queens Medical Centre, Nottingham University Hospitals NHS Foundation Trust, Nottingham, NG7 2UH, UK

    Murtaza Salem

  2. Department of Vascular Surgery, Level 1 North Wing, Guys & St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, Westminster Bridge Rd, London, SE1 7EH, UK

    Mohammed Sayed Hosny, Federica Francia, Morad Sallam, Prakash Saha, Sanjay Patel, Said Abisi & Hany Zayed

  3. Leicester Biomedical Research Centre (BRC), Leicester Vascular Institute and National Institute for Health Research (NIHR), Leicester, UK

    Athanasios Saratzis

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Salem, M., Hosny, M.S., Francia, F. et al. Management of Extensive Aorto-Iliac Disease: A Systematic Review and Meta-Analysis of 9319 Patients. Cardiovasc Intervent Radiol 44, 1518–1535 (2021). https://doi.org/10.1007/s00270-021-02785-6

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