Long-term patency of aortoiliac stenting with or without simultaneous infrainguinal revascularization: a propensity score-matched 10-year retrospective cohort study

Purpose: This study investigated the long-term impact of simultaneous infrainguinal revascularization on the primary patency rate (PPR) of aortoiliac artery stenting (AIS) for aortoiliac occlusive disease. Methods: A retrospective analysis of 334 consecutive AIS patients (2009-2024) was conducted. Patients were categorized into 2 groups: AIS with simultaneous infrainguinal treatment (Tx (+), n = 114) and AIS alone (Tx (-), n = 220). Baseline and lesion characteristics were compared. The primary outcome was 10-year PPR, analyzed using the Kaplan-Meier methods and log-rank tests, both before and after 1:1 propensity score matching for clinical and anatomical risk factors. Results: The Tx (+) group demonstrated a higher disease burden, including older age, lower body mass index, adverse lab findings, more severe calcification (P = 0.013), and greater external iliac artery involvement (P < 0.001). The overall PPR was excellent, stabilizing at 85.3% over 7 to 10 years. Before propensity matching, the Tx (-) group showed significantly superior patency (P = 0.004). However, after 1:1 propensity score matching, the difference in PPR between the Tx (+) and Tx (-) groups was no longer statistically significant (P = 0.093). Stent type did not significantly affect PPR (P = 0.220). Conclusion: Aortoiliac stenting offers durable long-term primary patency over 10 years. Although patients requiring combined infrainguinal revascularization have higher clinical and anatomical risks, simultaneous infrainguinal treatment does not independently compromise the long-term patency of the upstream aortoiliac stent. These findings support comprehensive revascularization to optimize limb perfusion without negatively impacting the iliac stent's long-term performance.