Covered Stents for Endovascular Treatment of Aortoiliac Occlusive Disease: A Systematic Review and Meta-Analysis

Abstract

Purpose: The treatment of aortoiliac occlusive disease (AIOD) has largely shifted to endovascular techniques, with primary stenting constituting the preferred treatment approach. The goal of the current study was to summarize available literature and to determine whether covered stents are superior to bare metal stents for the treatment of AIOD, in terms of both periprocedural and long-term outcomes. Methods: A meta-analysis of 47 studies was conducted with the use of random effects modeling. The incidence of adverse events during follow up among the individual included studies was synthesized. Results: Most of the lesions were located at the common iliac arteries and were chronic total occlusions. The procedure was technically successful in almost all cases in both groups, with a low rate of periprocedural complications observed in both groups. The reported primary patency rates for the non-covered and covered stent group during an average follow up of 24.3 months among the individual studies, were 84% and 92% respectively, while surgical or endovascular re-intervention was required in 10% of non-covered stent cases and in 6% of covered stent cases. Eight studies comparing covered vs non-covered stents in terms of patency demonstrated superiority of covered stents (OR: 2.47; 95% CI: 1.01-6.01; p = 0.047 Combining TASC C/D lesions together 12 studies reported 92% (95%CI:89%-95%) primary patency in the covered stent group, while 7 studies reported 75% (95%CI: 60%-88%) primary patency for cases treated with non-covered stents. Conclusion: This study demonstrated that covered stents are safe and effective when utilized for the treatment of AIOD. Covered stents were associated with a statistically significant higher odds of primary patency in both the overall cohort and in more complex TASC C/D lesions. However, additional high-quality comparative analyses between covered vs bare metal stents and between several types of covered stents are needed to determine the most optimal treatment modality for AIOD.

Off-label use of interwoven carotid stent in common femoral artery occlusion after surgery

“…However, we believe that the structure of the external nitinol layer, very similar to that of the Supera stent, could represent a key feature of this tool for use in the CFA. Finally, the internal micromesh layer ensures high coverage of the treated artery, potentially leading to a reduction in restenosis, which has been observed in other sites with covered stents, 9 , 10 but has not yet been tested on CFA and DFA with this device.…”

Different Methods of Endovascular Techniques in Management of Aorto-Iliac Occlusive Disease

“…The use of covered stents may result in the exclusion of arterial collateral pathways, notably the inferior mesenteric artery (IMA). However, these arteries are often occluded in stenotic lesions (8) .…”

“…In the treatment of AIOD, bare-metal stents are both safe and efficacious. In both the general cohort and the more severe TASC C/D lesions, bare-metal stents were linked with a statistically substantial enhance in the chance of primary patency (8) .…”

FORWARD Study of GORE VIABAHN Balloon-Expandable Endoprostheses and Bare Metal Stents in the United States, European Union, United Kingdom, Australia, and New Zealand When Placed to Treat Complex Iliac Occlusive Disease: Protocol for a Randomized Superiority Trial

“…This study is designed with the assumption that 1-year primary patency will be 88% and 70% for the VBX device group and BMS group, respectively. The study assumptions are based on the FLEX clinical study data and a recent meta-analysis of covered stents and BMS (both balloon-expandable and self-expanding) in patients with TASC II C and D lesions with a minimum of 12-month follow-up [ 11 ].…”