Stent-supported reconstruction of the aortoiliac bifurcation with the kissing balloon technique

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.