Endovascular Therapies Of TASC?C And D Aortoiliac Occlusive Disease With Covered Stent And Bare Stent Effect Analysis

Objective:Trans-Atlantic Inter-Society Consensus?(TASCII)C and D aortoiliac occlusive disease(AIOD)is a complex type of multisegment Peripheral arterial disease.Aortobifemoral bypass(ABF)is the classic treatment.With the progress of endovascular technology,the innovation of equipment and the change of treatment concept,the indications for endovascular therapies are constantly expanding,and it has become the preferred treatment method for AIOD.By analyzing the effects of two different types of stents(covered stent and bare stent),the clinical efficacy of endovascular therapies of complex TASCII C and D AIOD was further explored,which provided a reference for clinical work.Methods:Patients who were diagnosed as TASCII C and D AIOD and percutaneous transluminal angioplasty(PTA)+ stent implantation were selected from June 2015 to June 2018 in the Department of Vascular Surgery,Shanxi Provincial People's Hospital.A total of 78 cases were retrospectively analyzed.According to the different types of stents,they were divided into two groups: covered stent group(38 cases)and bare stent group(40 cases).Data recorded included gender,age,preoperative ABI,preoperative comorbidities(hypertension,diabetes,hyperlipidemia,coronary heart disease,cerebral infarction,renal insufficiency),perioperative complications,and patient contact numbers.The data were analyzed by SPSS13.0 statistical software,and the first-stage patency rate were analyzed by Kaplan-Meier method.Results:Endovascular therapies was successfully performed in 78 patients with a technical success rate of 100%.Among them,3 patients suffered from iliac artery rupture during predilatation,and covered stent was implanted directly;1 patient suffered from iliac artery rupture after bare stent implantation,and covered stent was implanted remedially during operation.Follow-up period ranged from 2 to 30 months,with an average of(25 ± 8)months.The first-stage patency rate of covered stent group and bare stent group were 92.1% and 72.5% respectively in 24 months.The 24 month first-stage patency rate of the covered stent graft group was higher than that of the bare stent group(P = 0.018),and the difference was statistically significant.In the covered stent group,3 patients had complications,including 2 cases of distal embolism and 1 case of puncture point hematoma.The complication rate was 7.9%.In bare stent group,complications occurred in 4 patients,including 1 case of distal embolism,2 cases of hematoma formation at puncture point and 1 case of pseudoaneurysm at puncture site.The complication rate was 10.0%.There was no significant difference in postoperative complication rate between the two groups(P=1.000),and no perioperative death occurred.Conclusion:Endovascular therapies of TASCII C and D aortoiliac occlusive disease is a safe and effective method.There was no difference in complications between covered stent and bare stent,but covered stent could be used as a remedial measure for accidental rupture of arteries.The 24 month first-stage patency rate of covered stent is significantly higher than that of bare stent,but the long-term efficacy of covered stent still needs the results of long-term follow-up of large sample.