LAUSR

INTRODUCTION The endovascular treatment (EVT) of peripheral artery obstructive disease in TASC-C and D lesions involving the aortic bifurcation is a matter of debate. The aim of this study is to evaluate the technical and clinical success of kissing stenting in this context and to analyze predictors of outcome. METHODS All patients treated for aorto-iliac TASC-C and D lesions with kissing stenting (from 2012 to 2017) in a 6-year period were retrospectively analyzed. Preoperative anatomical features were evaluated by reviewing Computed Tomography Angiography images in order to identify severe (SIC) vs. not severe iliac calcifications (NSIC). Primary endpoints: Technical Success (TS), Procedural Success (PS), Primary Patency (PP), and Clinical Success (CS). Secondary endpoints: Secondary Patency (SP), Assisted Patency (AP), Survival (S), mid-term procedure-related complications and risk factors that affected TS and mid-term results. RESULTS In a 6-year period, 51 patients fulfilled the inclusion criteria. TS was achieved in 49 (96.1%) cases. Thirty-one patients (60.8%) received a dual antiplatelet therapy (DAPT) for at least 1 month after the procedure. 30-day CS was 94.1%. Median follow-up was 45.7 months (IQR: 24.5, 8-86 range). The CS was 92.6% at 3 years, with a PP of 86.8% and a secondary patency of 93.2% at 3 years. Six (13.2%) iliac axis occluded during the first follow-up year. NSIC was statistically and independently associated with a lower PP (73% vs 96%, P= 0.03); DAPT was statistically and independently associated with higher PP compared to single antiplatelet therapy (96% vs 75%, P= 0.03); these results were confirmed by Cox-regression analysis (HR:0.14, 95%,IC:0.01-0.89, P= 0.05 for DAPT analysis; HR:6.8, 95%,IC:1.21-59, P= 0.05 for NSIC analysis). CONCLUSIONS EVT for TASC C-D is an effective technique. Postoperative stent occlusion is higher in patients with no DAPT and it usually occurs during the first post-operative year. Preoperative NSIC lesions are associated with reduced PP at 3 years of follow-up.