(PC090) Covered versus Uncovered Stents for Aortoiliac Occlusive Disease in the Vascular Quality Initiative

Objectives: There remain conflicting data regarding the advantages of covered stents (CS) versus uncovered stents (US) for aortoiliac occlusive disease. The COBEST trial reported higher patency rates of CS particularly in TASC C/D lesions, whereas subsequent studies such as the DISCOVER trial did not find significant differences. The Gore VBX FORWARD study is currently enrolling to compare these two modalities. As such, we sought to compare the outcomes between US and CS in the VQI.

Methods: All patients undergoing US or CS with or without plain balloon angioplasty of the common iliac, external iliac, or both arteries for aortoiliac occlusive disease between 2016 and 2023 were identified in the VQI. Patients with prior inflow stenting, prior ipsilateral surgical bypass, or concomitant procedures such as an atherectomy were excluded. One-to-one propensity score matching was performed using patient comorbidities, demographics, medications, and lesion characteristics as covariates. The primary outcome included primary patency at 1-year, defined as no evidence of >50% stenosis, occlusion, and without a target lesion revascularization (TLR). Secondary outcomes included 5-year mortality and technical success. Outcomes were evaluated using Chi-squared tests, Kaplan-Meier estimates, and Log-rank tests.

Results: Overall, 6,881 patients underwent US and 2,245 underwent CS. After matching, 1,722 pairs of patients were included in our study with no baseline differences between the two groups (US: mean [SD] age, 66.1 [10.0] years; 56% male; CS: 66.1 [10.4] years; 57% male). Target lesion location was similar: common iliac (76% US vs. 76% CS), external iliac (16% vs. 15%), and both common and external (8% vs. 9%, p = 0.6, Table I). Indication was also similar: claudication (71% vs 71%), rest pain (18% vs. 18%), and tissue loss (11% vs. 11%, p = 0.9). Overall, there were no significant differences in primary patency at 1-year (92% vs. 92%, p = 0.8, Fig 1) and 5-year mortality (93% vs. 91%, p = 0.4). For TASC C/D lesions, primary patency at 1-year remained similar (92% vs. 91%, p = 0.5). No differences in primary patency were seen for patients treated for claudication (94% vs. 94%, p = 0.9) versus rest pain/tissue loss (89% vs. 89%, p = 0.8). Technical success was the same between the groups (99% vs. 99%, p = 0.9).

Conclusions: In this one-to-one propensity matched retrospective analysis, US and CS had similar rates of primary patency, mortality, and technical success. Further long-term patency analysis is needed to elucidate the appropriate use of US and CS.