D. Scheinert et al., Stent-supported reconstruction of the aortoiliac bifurcation with the kissing balloon technique, CIRCULATION, 100(19), 1999, pp. 295-300
Citations number
25
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background-Bilateral iliac artery obstructions involving the aortic bifurca
tion or high-grade stenosis of the abdominal aorta are not usually consider
ed an indication for percutaneous treatment. The purpose of the present stu
dy was to evaluate the initial and long-term results of primary stent impla
ntation for reconstruction of the aortic bifurcation.
Methods and Results-In 48 patients with obstructions of the aortoiliac segm
ent, primary stent implantation was performed with the "kissing balloon tec
hnique." Preinterventional angiography showed bilateral stenoses (>85%) of
the proximal common iliac arteries in 25 patients, unilateral occlusions an
d contralateral stenosis in 22 patients, and bilateral occlusion in 1 patie
nt. In 7 cases, stents were placed for the treatment of high-grade infraren
al aortic stenoses. After excimer laser-assisted recanalization of the comm
on iliac artery obstructions, the aortic bifurcation was reconstructed with
the bilateral simultaneous implantation of Palmaz stents (diameter, 7 to 8
mm). Stents used for the treatment of aortic stenoses (Palmaz, n = 6; Gian
turco, n = 1) had a diameter ranging from 20 to 25 mm. In all patients, ste
nts were placed successfully (residual stenosis <30%) and without complicat
ions. A clinical improvement of +2 to +3 according to American Heart Associ
ation criteria was observed in 41 and 7 patients, respectively. Follow-up w
as performed clinically (standardized treadmill resting and color-coded Dop
pler ultrasound) and angiographically. The primary angiographic patency rat
e (24-month follow-up) was 86.8%. In 3 patients, angiography revealed signi
ficant restenoses, which were successfully treated with percutaneous transl
uminal angioplasty.
Conclusions-Primary stent implantation with the kissing balloon technique i
s safe and effective for the treatment of aortoiliac obstructions involving
the aortic bifurcation and represents a true endovascular alternative to s
urgery.