Outcomes of the single-stent versus kissing-stents technique in asymmetric complex aortoiliac bifurcation lesions

Abstract

The single-stent technique in ACAB was safe and showed midterm outcomes comparable with those of kissing stents. Considering the benefits, such as fewer stents, less bilateral femoral access, and the availability of contralateral access for future intervention, the single-stent technique may be an advantageous treatment option in ACAB.

Valve-Like and Protruding Calcified Intimal Flap Complicating Common Iliac Arteries Kissing Stenting

“…However, the development of stents to treat failed angioplasty led to the inability to cross back into the true lumen after crossing the occluded segment, becoming the primary cause for acute procedural failure in the treatment of iliac CTOs. Total unilateral iliac arterial axis occlusion can be approached in a similar way, as described by Palmaz et al [ 12 ], with omission of the contralateral stent especially if the contralateral CIA ostium has no disease or has an intermediate stenosis [ 3 ]. However, in asymmetric aortoiliac lesions the application of large displacement forces to severely calcified and irregularly shaped plaques during unilateral iliac artery dilatation may augment contralateral iliac occlusion due to plaque shifting and embolization to the contralateral iliac artery.…”

“…Currently, there is no consensus whether the kissing stents technique offers an advantage over the single-stent stenting strategy [ 3 , 4 ]. Furthermore, studies showed that stent type or stent configuration (single, V or kissing) is not a predictor of primary patency in true bifurcation lesions [ 4 , 14 ].…”

“…Furthermore, studies showed that stent type or stent configuration (single, V or kissing) is not a predictor of primary patency in true bifurcation lesions [ 4 , 14 ]. Most authors have reported favorable results after reconstructing the aortoiliac bifurcation with the kissing stent technique, with technical success rates between 89% and 100% [ 3 , 4 , 8 ] and with primary patency rates between 76% and 98% at 1 year [ 3 , 4 , 8 , 15 ] and between 77.6% and 87% during a follow-up of 30–36 months [ 3 , 14 , 15 ]. Secondary patency rates were estimated to be 98.2% at 1 year [ 4 ] and between 97.5% and 98% at 36 months [ 3 , 15 ].…”

“…This procedure reportedly results in 80–90% patency at 5 and 10 years, although according to a meta-analysis it is associated with an aggregated operative mortality rate of 4.4% and a major-complication rate of 12.1% [ 2 ]. However, endovascular therapy for TASC II C/D lesions has also evolved during the past 2 decades [ 1 , 3 , 4 ] offering less invasive treatment and shorter hospital stays, and, notably, treatment of TASC D lesions is increasingly adopted as a first-line management option, not only for patients considered unfit enough for open surgical treatment [ 3 – 5 ]. Recent studies using bare metal stents in the common iliac arteries (single or bilateral with an overlap in the distal aorta) for the treatment of bilateral aortoiliac occlusive disease have demonstrated a high rate of technical success, good mid- and long-term patency, and low procedural morbidity and mortality [ 3 , 4 , 6 – 8 ].…”

“…Occasionally, procedure-related complications may occur in both single- or kissing stent technique, necessitating various troubleshooting techniques or bailout procedures [ 3 ]. We describe herein the case of a patient presenting with an ischemic left foot digit ulcer and suffering left common iliac artery (CIA) CTO and contralateral CIA severe stenosis, who received CIA kissing stents.…”