Ann Surg Treat Res.  2021 Oct;101(4):247-255. 10.4174/astr.2021.101.4.247.

Midterm results of kissing stent reconstruction of the aortoiliac bifurcation

• Serefli D
• Saydam O
• Engin AY
• Atay M

• KMID: 2520656
• DOI: http://doi.org/10.4174/astr.2021.101.4.247

Abstract

Purpose
One subset of peripheral arterial disease is aortoiliac occlusive diseases (AIOD). AIOD is the term for all arterial lesions between the infrarenal distal aorta and common femoral artery. Implantation of kissing stents (KS) with covered stents (CS), bare-metal stents (BMS) is one of the endovascular treatment (ET) modalities for AIOD involving aortic bifurcation. In this study, we report the outcomes of the KS technique in infrarenal AIOD.
Methods
Between January 2014 and September 2017, 31 patients who underwent ET were treated with KS technique either with balloon-expandable BMS or balloon-expandable CS. Technical details, clinical success, complications, and patency at follow-up were documented.
Results
The majority of patients were male (77.4%), and the median age was 62 years (range, 45–78 years). All patients were classified according to the TASC II criteria. Eight patients (25.8%) were classified as TASC B. Fifteen patients (48.4%) were classified as TASC C, and 8 patients (25.8%) were classified as TASC D. These 23 patients were classified as complex AIOD group. BMS was used in 17 patients (54.8%), and CS was used in 14 patients (45.2%). Technical and clinical success was achieved in 100% of treated cases. The median follow-up was 24 months (range, 24–34 months). Primary patency rates at 12, 18, and 24 months after ET were 100%, 96.8%, and 90.3%, respectively. 
Conclusion
We found that the KS technique has satisfying 24-month results, even in complex AIOD lesions, with high technical success and acceptable midterm patency.

Keyword

Aorta; Arterial occlusive diseases; Endovascular procedures; Iliac artery; Stents

Figure

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  Fig. 1 (A) Initial anteroposterior image from angiogram shows chronic total occlusion of the right common iliac artery, including its origin and near occlusion of the proximal of the left common iliac artery. (B) Ultimate angiogram shows the treatment with kissing stents (KS) technique of the lesions. (C) Initial anteroposterior image from angiogram shows severe infrarenal aortic stenosis involving bilateral common iliac arteries. (D) Ultimate angiogram shows the treatment with KS technique of the lesions.

• 

  Fig. 2 Kaplan-Meier survival curve shows improved patency of the bare-metal stents vs. the covered stents.

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