Background: The aim of this study was to evaluate outcomes of extensive iliofemoral reconstruction combining both iliac covered kissing stents (ICKS) with stenting of the external iliac artery (SEIA) and/or surgical femoral endarterectomy (SFE).
Methods: From November 2010 to November 2017, patients with extensive iliofemoral occlusive disease-classified as Trans-Atlantic Inter-Society Consensus class D-treated by ICKS in combination with SEIA and/or SFE were included. Patients received ICKS + SEIA, ICKS + SFE, or ICKS + SEIA + SFE. Demographics, procedure details, and postoperative outcomes were recorded. Primary end points were primary patency (PP), primary assisted patency (PAP), and secondary patency (SP). Long-term patency was assessed by annual clinical and ultrasonographic examination.
Results: Among 156 consecutive ICKS procedures performed during the study period, 59 patients were included (81% men; median age, 65 years). In all, 32 patients (54%) underwent ICKS + SEIA, 17 (29%) patients underwent ICKS + SFE, and 10 (17%) patients underwent ICKS + SEIA + SFE. Operative indication was either disabling claudication (n = 46, 78%) or critical limb-threatening ischemia (n = 13, 22%). A total of 92 limbs were revascularized, including 121 covered balloon-expandable stents and 65 self-expanding nitinol stents, with 100% technical success. Thirty-day mortality was 3% (2/59) and 5 (8%) patients suffered from local complications, with no early reintervention. Long-term patency rates were as follows: at 2 years, overall PP, PAP, and SP were 82%, 86%, and 96%, respectively; at 5 years, overall PP, PAP, and SP were 73%, 79%, and 95%, respectively. After a mean follow-up of 34 ± 29 months, 25% (15/59) patients underwent late reinterventions for either de novo iliac or femoral stenosis (n = 9), iliac occlusion (n = 4), or external iliac in-stent restenosis (n = 2).
Conclusions: Treatment of extensive iliofemoral occlusive disease involving ICKS in combination with SEIA and/or SFE is safe and effective, providing satisfactory long-term secondary patency, at the price of a significant reintervention rate.
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