Evaluation Of Viabahn Covered Stent In The Treatment Of Aortoiliac Arteriosclerosis Obliterans

ObjectiveAortoiliac occlusive disease(AIOD)is a common disease in the field of vascular surgery,the main manifestation of which is chronic ischemia of the lower extremities.If the clinical intervention is not timely,it may develop into amputation,which will seriously affect the quality of patients' life.The clinical data of 55 patients with aortoiliac arteriosclerosis occlusion were included in this study.The clinical effects and short-term and medium-term patency rates of the patients treated with Viabahn covered stent and bare stent were compared and analyzed,which could provide relevant clinical reference for interventional therapy of aortoiliac arteriosclerosis stenosis or occlusion.MethodsThe clinical data of 55 patients with aortoiliac arteriosclerosis obliterans admitted to the vascular surgery department of the Fifth Affiliated Hospital of Zhengzhou University from January 2016 to January 2018 were retrospectively studied.There were 25 patients in the Viabahn covered stent group and 30 patients in the bare metal stent group.The average follow-up period was 24 months.The basic conditions of the lesions were evaluated by color Doppler ultrasonography,computed tomography angiography(CTA)and digital silhouette angiography(DSA).The ankle-brachial index(ABI),Fontaine staging,patency rate and other indicators were recorded during the treatment and follow-up stage.The data of the two groups was statistically processed and analyzed.ResultsThe operation was successful in both groups,and the affected limbs were recanalized.There were no serious adverse events such as arterial rupture,dissection,death and so on.1.Surgical results and perioperative complications: In Viabahn covered stent group,the intermittent claudication distance was increased from(124.88±28.50)m preoperatively to(497.72±75.20)m postoperatively(P < 0.001);the ankle-brachial index was increased from 0.26 +0.10 preoperatively to 0.94 +0.11 postoperatively(P < 0.001),and the incidence of complications was 12.0%(3/25).In bare metal stent group,the distance of intermittent claudication increased from(113.47±23.39)m preoperatively to(471.53±78.27)m postoperatively(P < 0.001);the ankle-brachial index increased from(0.23±0.07)preoperatively to(0.90±0.09)postoperatively(P < 0.001),and the incidence of complications was 16.7%(5/30).There was no significant difference in the intermittent claudication distance,ABI value and the incidence of perioperative complications between the two groups(P=0.214,0.153,0.625).2.Ankle brachial index and Fontaine staging: The ABI values of the two groups at different stages were compared and analyzed.There was no significant difference in ABI values at 3 and 6 months after operation(P > 0.05).At 12 and 24 months after operation,the ABI values of bare metal stent group decreased faster than that of Viabahn covered stent group(P < 0.05).There was no significant difference in the proportion of Fontaine stages between the two groups before operation(P > 0.05).The clinical symptoms of the patients after operation were alleviated to a certain extent which were in stage II a(mild intermittent claudication)or below.There was no significant difference in the changes of Fontaine stages at 3,6,12 and 24 months after operation(P > 0.05).3.Primary patency rate and target lesion revascularization rate(TLR): The primary patency rates of target lesions in Viabahn covered stent group and bare metal stent group at 3,6,12 and 24 months after operation were 100%,96.0%,92.0%,84.0% and 93.3%,86.7%,76.7%,70.0%,respectively.Log-rank test showed that there was no significant difference in primary patency rate between the two groups(P=0.205).Further analysis showed that there was no significant difference in the primary patency rate between the two groups of TASC II B,C,and D lesions(P > 0.05).In Viabahn covered stent group,there were 4 patients with more than 50% stent stenosis,2 of which were improved after symptomatic treatment,2 patients underwent re-surgery with a TLR rate of 8.0%.In the bare metal stent group,the TLR rate was 30.0%,there were 9 patients with more than 50% stent stenosis which were all treated with surgical intervention.4.Limb salvage rate and stent fracture rate: One amputation occurred in Viabahn covered stent group after operation.During the follow-up period,the symptoms were aggravated,followed by dry gangrene of lower limbs.The limb salvage rate was 96.0%.In bare metal stent group,2 amputations were performed,and 2 cases were poorly controlled due to ulcer and secondary gangrene.The limb salvage rate was 93.3%.There was no stent fracture in either group.Conclusions1.According to the data of this study,the clinical efficacy of Viabahn covered stent and bare metal stent in the treatment of aortoiliac arteriosclerosis obliteration is similar,and there is no significant difference between short-term and medium-term patency rates;2.For aortoiliac arteriosclerotic occlusion lesions,Viabahn covered stents have a lower intervention rate than bare stents,providing a reference for the treatment of this type of disease.