Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Long-Term Clinical Outcomes of Iliac Artery Endovascular Therapy in the Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Diseases (K-VIS ELLA) Registry

  • Ji Woong Roh (Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital) ;
  • Sanghoon Shin (Department of Cardiology, Ewha Womans University Medical Center, Ewha Womans University) ;
  • Young-Guk Ko (Department of Cardiology and Cardiovascular Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Nak-Hoon Son (Division of Biostatistics, Yongin Severance Hospital, Yonsei University College of Medicine) ;
  • Chul-Min Ahn (Department of Cardiology and Cardiovascular Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Pil-Ki Min (Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Jae-Hwan Lee (Division of Cardiology, Chungnam National University Sejong Hospital) ;
  • Chang-Hwan Yoon (Division of Cardiology, Seoul National University Bundang Hospital) ;
  • Cheol Woong Yu (Division of Cardiology, Korea University Anam Hospital) ;
  • Seung Whan Lee (Division of Cardiology, Asan Medical Center, Ulsan University College of Medicine) ;
  • Sang-Rok Lee (Division of Cardiology, Jeonbuk National University Hospital) ;
  • Seung Hyuk Choi (Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • In-Ho Chae (Division of Cardiology, Seoul National University Bundang Hospital) ;
  • Donghoon Choi (Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital)
  • Received : 2021.11.30
  • Accepted : 2022.03.10
  • Published : 2022.07.01
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Abstract

Background and Objectives: Limited data are available regarding long-term clinical outcomes of iliac artery endovascular therapy (EVT) in real-world practice. This study investigated long-term outcomes according to Trans-Atlantic Inter-Society Consensus (TASC) classifications. Methods: We analyzed data from 1,705 limbs of 1,364 patients from the retrospective cohort of the multicenter Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Disease registry. The primary endpoint was target lesion revascularization (TLR)-free survival. Results: TASC A, B, C, and D lesions were present in 19.4%, 26.2%, 28.7%, and 25.7% of the treated limbs, respectively. The technical success rate was 96.2% and did not differ between TASC lesion types. Complications occurred in 6.8% of cases and more occurred in TASC D (11.8%). Iliac artery EVT showed a 5-year TLR-free survival of 89.2%. The TASC D group had the lowest TLR-free rate of 79.3%. TASC D (hazard ratio [HR], 1.75; 95% confidence interval [CI], 1.12-2.73; p=0.014), plain old balloon angioplasty (HR, 4.25; 95% CI, 2.03-8.88; p<0.001), current smoker (HR, 1.89; 95% CI, 1.26-2.83; p=0.002), previous bypass surgery (HR, 3.04; 95% CI, 1.28-7.19; p=0.011), combined femoropopliteal treatment (HR, 4.89; 95% CI, 3.19-7.50; p<0.001), combined below the knee treatment (HR, 2.20; 95% CI, 1.25-3.89; p=0.007), and complications (HR, 1.86; 95% CI, 1.07-3.24; p=0.028) were predictors for TLR. Conclusions: Iliac artery EVT achieved excellent technical success and 5-year TLR-free survival. TASC D showed a favorable but lower 5-year TLR-free survival rate and higher complication rate compared with other TASC groups.

Keywords

Acknowledgement

This research was supported by grants from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI) and a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (HC20C0081), the Korea Medical Device Development Fund funded by the Korean government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (202011B29-03, 202011D12-02) and the Cardiovascular Research Center (Seoul, Korea).

References

  1. Criqui MH, Matsushita K, Aboyans V, et al. Lower extremity peripheral artery disease: contemporary epidemiology, management gaps, and future directions: a scientific statement from the American Heart Association. Circulation 2021;144:e171-91. https://doi.org/10.1161/CIR.0000000000001005
  2. Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol 2017;69:e71-126. https://doi.org/10.1016/j.jacc.2016.11.007
  3. Aboyans V, Ricco JB, Bartelink ME, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Endorsed by: the European Stroke Organization (ESO). The task force for the diagnosis and treatment of peripheral arterial diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 2018;39:763-816. https://doi.org/10.1093/eurheartj/ehx095
  4. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 2007;45 Suppl S:S5-67. https://doi.org/10.1016/j.jvs.2006.12.037
  5. Indes JE, Pfaff MJ, Farrokhyar F, et al. Clinical outcomes of 5358 patients undergoing direct open bypass or endovascular treatment for aortoiliac occlusive disease: a systematic review and meta-analysis. J Endovasc Ther 2013;20:443-55. https://doi.org/10.1583/13-4242.1
  6. Premaratne S, Newman J, Hobbs S, Garnham A, Wall M. Meta-analysis of direct surgical versus endovascular revascularization for aortoiliac occlusive disease. J Vasc Surg 2020;72:726-37. https://doi.org/10.1016/j.jvs.2019.12.035
  7. Rossi M, Iezzi R. Cardiovascular and Interventional Radiological Society of Europe guidelines on endovascular treatment in aortoiliac arterial disease. Cardiovasc Intervent Radiol 2014;37:13-25. https://doi.org/10.1007/s00270-013-0741-9
  8. Ko YG, Ahn CM, Min PK, et al. Baseline characteristics of a retrospective patient cohort in the Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Diseases (K-VIS ELLA) Registry. Korean Circ J 2017;47:469-76. https://doi.org/10.4070/kcj.2017.0020
  9. Society for Vascular Surgery Lower Extremity Guidelines Writing Group, Conte MS, Pomposelli FB, et al. Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg 2015;61:2S-41S. https://doi.org/10.1016/j.jvs.2014.12.009
  10. European Stroke Organisation, Tendera M, Aboyans V, et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the task force on the diagnosis and treatment of peripheral artery diseases of the European Society of Cardiology (ESC). Eur Heart J 2011;32:2851-906. https://doi.org/10.1093/eurheartj/ehr211
  11. de Donato G, Bosiers M, Setacci F, et al. 24-month data from the BRAVISSIMO: a large-scale prospective registry on iliac stenting for TASC A & B and TASC C & D lesions. Ann Vasc Surg 2015;29:738-50. https://doi.org/10.1016/j.avsg.2014.12.027
  12. Piffaretti G, Fargion AT, Dorigo W, et al. Outcomes from the multicenter italian registry on primary endovascular treatment of aortoiliac occlusive disease. J Endovasc Ther 2019;26:623-32. https://doi.org/10.1177/1526602819863081
  13. Jongkind V, Akkersdijk GJ, Yeung KK, Wisselink W. A systematic review of endovascular treatment of extensive aortoiliac occlusive disease. J Vasc Surg 2010;52:1376-83. https://doi.org/10.1016/j.jvs.2010.04.080
  14. Suzuki K, Mizutani Y, Soga Y, et al. Efficacy and safety of endovascular therapy for aortoiliac TASC D lesions. Angiology 2017;68:67-73. https://doi.org/10.1177/0003319716638005
  15. Cakmak EO, Bayam E, Yilmaz F, et al. Midterm outcomes on primary endovascular treatment of 395 aortoiliac occlusive disease patients: a single-center experience. Angiology 2021;72:640-50. https://doi.org/10.1177/0003319721991378
  16. Bechter-Hugl B, Falkensammer J, Gorny O, Greiner A, Chemelli A, Fraedrich G. The influence of gender on patency rates after iliac artery stenting. J Vasc Surg 2014;59:1588-96. https://doi.org/10.1016/j.jvs.2014.01.010
  17. Psacharopulo D, Ferrero E, Ferri M, et al. Increasing efficacy of endovascular recanalization with covered stent graft for TransAtlantic Inter-Society Consensus II D aortoiliac complex occlusion. J Vasc Surg 2015;62:1219-26. https://doi.org/10.1016/j.jvs.2015.06.218
  18. Ye W, Liu CW, Ricco JB, Mani K, Zeng R, Jiang J. Early and late outcomes of percutaneous treatment of TransAtlantic Inter-Society Consensus class C and D aorto-iliac lesions. J Vasc Surg 2011;53:1728-37. https://doi.org/10.1016/j.jvs.2011.02.005
  19. Kim DY, Ko YG, Lee SJ, et al. Korean multicenter registry study of EPIC stents for the treatment of iliac artery disease: K-EPIC registry. Korean Circ J 2021;51:441-51. https://doi.org/10.4070/kcj.2020.0420