Elsevier

Annals of Vascular Surgery

Volume 72, April 2021, Pages 667.e1-667.e9
Annals of Vascular Surgery

Case Report Abstract
Outcomes Analysis of Surgical Conversion for Kissing-Stent Occlusion

https://doi.org/10.1016/j.avsg.2020.10.041Get rights and content

Highlights

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    Type of research: Bi-centric, retrospective, observational cohort analysis.

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    Key findings: Patient’s status frequently worsens after kissing-stent occlusion in comparison to the initial clinical status. Open conversion with aortoiliac-femoral reconstruction and kissing-stent explantation is feasible, safe with durable mid-term results.

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    Take home message: Open aortic reconstruction after KS occlusion was feasible and effective. Endovascular repair for aortoiliac obstructive disease may be pursued as first-line treatment even in complex lesions.

Background

We aimed to describe the operative outcomes following open aortoiliac/femoral graft reconstruction for bilateral kissing-stent (KS) occlusion.

Methods

This is a bicentric, retrospective, observational cohort study. Between September 2007 and December 2019, 205 patients were treated with KS for aortoiliac reconstruction. Only those who had bilateral KS occlusion with subsequent aortoiliac/femoral graft replacement were included in this analysis. Primary outcomes were early (<30 days) and late survival, postoperative (<30 days) complications, and patency rates.

Results

Nine patients (male, n = 7) were analyzed. The patient’s mean age was 60 ± 5 years (range 55–62). Median delay from initial KS procedure was 36 months (interquartile range [IQR] 19–252). On admission, all patients presented with a worse Rutherford class compared to their initial pre-KS clinical presentation. Aortobifemoral bypass was performed in 5 patients, and aortobi-iliac reconstruction in 4 patients. There were no perioperative deaths and only 1 new case of erectile dysfunction occurred. At a median follow-up time of 24 months (IQR 12–54), primary patency rate was 88.9%.

Conclusions

Open aortic reconstruction after KS occlusion was feasible and effective. Endovascular repair for aortoiliac obstructive disease may be pursued as first-line treatment even in complex lesions.

Introduction

Kissing-stent (KS) reconstruction of the aortic bifurcation for atherosclerotic occlusive disease has replaced traditional open surgery with many series documenting the procedure to be safe, effective, and sustained.1, 2, 3, 4, 5, 6 The current guidelines from professional cardiovascular associations consider an endovascular-first strategy a reasonable option for complex aortoiliac occlusive lesions if done by an experienced team and if the procedure does not compromise future open surgical reconstructive options.7, 8, 9 However, despite multiple clinical experiences published in the literature only a few open conversions have been reported with no documented KS explantation, as well as operative outcomes of open aortoiliac/femoral conversion are currently unknown.3, 4, 5,10,11 The aim of this study is to describe the operative outcomes following open conversion with aortoiliac/femoral graft reconstruction for bilateral KS occlusion.

Section snippets

Study Cohort

This is a retrospective, observational cohort study from 2 tertiary referral university hospitals.12 Data of patients with KS for atherosclerotic aortoiliac occlusive disease were collected in a prospectively maintained database. For this study, all patients treated with KS between September 2007 and December 2019 were identified. Only those who underwent open conversion with stent explantation and aortoiliac/femoral graft replacement for bilateral KS occlusion were included in the study cohort

Study Cohort

Overall, KS bilateral occlusion was documented in 12 (5.8%) patients. During the study period we treated 9 patients who met the inclusion criteria specifically for this analysis: 7 (3.4%) patients of the primary institutional cohort of KS (n = 205) and 2 additional patients who were transferred from another hospital. The mean age of patients was 60 ± 5years (range 55–62). Demographics, comorbidities, and risk factors are reported in Table I. Reason for KS occlusion was stent misalignment in 7

Discussion

This is the first series of which we are aware that specifically describes the outcomes of open conversion to aortoiliac/femoral reconstruction after KS explantation because of the bilateral stent occlusion.

KS reconstruction of the aortoiliac has gained respect and popularity for a vast majority of atherosclerotic lesions of the aortoiliac bifurcation.6 Although long-term results have not been similar to AbF bypass, the patency rates of KS are excellent and consistently reported.2,5 The most

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    Conflicts of Interest: None.

    Funding: This study is unfunded.

    Authors’ Contributions: G.P. helped in study design; G.P., M.C.C., and R.B. helped in data collection; G.P. and M.F. helped in data analysis; G.P. and W.D. helped in writing; and G.P., R.B., M.F., W.D., M.C.C, and M.T. helped in critical revision and final approval.

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