Joost A Bekken1, Hidde Jongsma2, Bram Fioole2. 1. Department of Vascular Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands - joostbekken@hotmail.com. 2. Department of Vascular Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands.
Abstract
INTRODUCTION: During the past decade, endovascular treatment has become the treatment of choice for all types of aortoiliac occlusive disease, including TASC C and D lesions. Patency rates, however, are still below those of open surgical techniques. One propagated technique to improve patency rates is the use of covered stents. This review assessed the available literature on covered stents for aortoiliac occlusive disease. EVIDENCE ACQUISITION: An extensive search was performed of the MEDLINE, Embase, and Cochrane databases. All studies reporting on covered stents, including stent grafts for endovascular aneurysm repair, were included. A systematic review and meta-analysis was performed. EVIDENCE SYNTHESIS: We identified 19 studies comprising 12 single-arm series, 6 retrospective series, and 1 randomized controlled trial. The meta-analysis did not show a significant difference in primary patency at 1, 2, and 3 to 5 years for covered stents compared with bare-metal stents (91.7% vs. 88.5%, 85.4% vs. 80.9%, and 80.7% vs. 72.0%, respectively). Several studies found a significant difference in TASC C and D lesions in favor of covered stents. CONCLUSIONS: High-quality evidence supporting the use of covered stents for aortoiliac occlusive arterial disease is limited. The use of covered stents in TASC C and D lesions may improve patency rates. However, because the TASC classification is very heterogeneous, more research is needed to identify specifically which lesion characteristics might benefit most from covered stent placement.
INTRODUCTION: During the past decade, endovascular treatment has become the treatment of choice for all types of aortoiliac occlusive disease, including TASC C and D lesions. Patency rates, however, are still below those of open surgical techniques. One propagated technique to improve patency rates is the use of covered stents. This review assessed the available literature on covered stents for aortoiliac occlusive disease. EVIDENCE ACQUISITION: An extensive search was performed of the MEDLINE, Embase, and Cochrane databases. All studies reporting on covered stents, including stent grafts for endovascular aneurysm repair, were included. A systematic review and meta-analysis was performed. EVIDENCE SYNTHESIS: We identified 19 studies comprising 12 single-arm series, 6 retrospective series, and 1 randomized controlled trial. The meta-analysis did not show a significant difference in primary patency at 1, 2, and 3 to 5 years for covered stents compared with bare-metal stents (91.7% vs. 88.5%, 85.4% vs. 80.9%, and 80.7% vs. 72.0%, respectively). Several studies found a significant difference in TASC C and D lesions in favor of covered stents. CONCLUSIONS: High-quality evidence supporting the use of covered stents for aortoiliac occlusive arterial disease is limited. The use of covered stents in TASC C and D lesions may improve patency rates. However, because the TASC classification is very heterogeneous, more research is needed to identify specifically which lesion characteristics might benefit most from covered stent placement.