Endovascular Approach Versus Aortobifemoral Bypass Grafting: Outcomes in Extensive Aortoiliac Occlusive Disease

• Type: Article in International Scientific Journal
• Date: 2020

Authors

Rocha Neves, J (Author) FMUP; Ferreira, A (Author) FMUP; Sousa, J (Author) FMUP; Pereira Neves, A (Author) FMUP; Vidoedo, J (Author) Other; Alves, H (Author) FMUP; Teixeira, J (Author) Other; Azevedo A (Author) FMUP

Journal

Title: Vascular and Endovascular Surgery

Vol. 54

Pages: 102-110

ISSN: 1538-5744

Publisher: SAGE

Indexing

ISI Web of Knowledge - 22 Citations

Scopus - 21 Citations

Other information

Authenticus ID: P-00R-DDN

DOI: 10.1177/1538574419888815

Abstract (EN): Objective: Compare technical, clinical, and economic outcomes between endovascular and open approaches in patients with type D aortoiliac occlusive disease according to the TransAtlantic Inter-Society Consensus. Methods: Patients undergoing revascularization for type D aortoiliac lesions, either endovascular or open surgery approach, from 2 Portuguese institutions between January 2011 and October 2017 were included. The surgical technique was left to the surgeon discretion. Patients with common femoral artery affection, both obstructive and aneurysmatic, were excluded. Results: Twenty-seven patients underwent aortobifemoral bypass and 32 patients were submitted to endovascular repair. The patients undergoing endovascular procedure were more likely to present with chronic heart failure (P = .001) and chronic kidney disease (P = .022) and less likely to have a history of smoking (P = .05). The mean follow-up period was 67.84 (95% confidence interval = 61.85-73.83) months. The open surgery approach resulted in a higher technical success (P = .001); however, limb salvage and patency rates were not different between groups. Endovascular approach was associated with a shorter length-of-stay, both inpatient (6 vs 9 days; P = .041) and patients admitted in the intensive care unit (0 vs 3.81 days; P = .001) as well as lower hospital expenses (US$9281 vs US$23 038; P = .001) with a similar procedure cost (US$2316 vs US$1173; P = .6). No differences were found in the postsurgical quality of life. Conclusion: Endovascular approach is, at least, clinically equivalent to open surgery approach and is more cost-efficient. The "endovascular-first" approach should be considered for type D occlusive aortoiliac lesions.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 9