A systematic review and meta-analysis comparing perioperative and patency outcomes of aortoiliac kissing stents versus aortic bifurcated bypass for TASC-II C/D aortoiliac occlusive disease.

PURPOSE To perform a meta-analysis comparing perioperative (30-day mortality, length of hospital stay, and acute kidney injury) and patency outcomes (primary, assisted primary, secondary, and freedom from reintervention) of aortoiliac kissing stents (KS) versus aortic bifurcated bypass surgery (ABBS) in patients with TASC-II C/D aortoiliac occlusive disease (AIOD).

MATERIALS AND METHODS MEDLINE, Embase, and Cochrane databases were searched from inception through June 2025. Inclusion was restricted to original studies comparing KS versus ABBS for TASC-II C/D AIOD with reported perioperative and patency outcomes. Pooled odds ratios (ORs), mean differences (MDs), and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a random-effects model.

RESULTS Four cohort studies involving 385 patients (215 KS, 170 ABBS) were included. No significant difference was observed between KS and ABBS groups in 30-day mortality (OR: 1.37; 95% CI: 0.04 to 49.96; p = 0.86) and acute kidney injury (OR: 0.65; 95% CI: 0.16 to 2.62; p = 0.54). KS was associated with a significantly shorter hospital stay (MD: -5.92 days; 95% CI: -8.47 to -3.36; p < 0.00001). Rates of primary patency (HR: 1.49; 95% CI: 0.25 to 8.96; p = 0.66), assisted primary patency (HR: 0.75; 95% CI: 0.08 to 6.74; p = 0.80), secondary patency (HR: 0.86; 95% CI: 0.13 to 5.69; p = 0.88), and freedom from reintervention (HR: 2.66; 95% CI: 0.52 to 13.66; p = 0.24) were similar between the compared interventions during follow-up.

CONCLUSION KS and ABBS demonstrate comparable patency and perioperative outcomes for TASC-II C/D AIOD.