Outcomes of Total Aortoiliac Revascularization for TASC-II C&D Lesion with Kissing Self-Expanding Covered Stents

Abstract

Background: The endovascular approach has been widely used for aortoiliac occlusive disease (AIOD), especially for aortic bifurcation and iliac artery Trans-Atlantic Inter-Society Consensus II (TASC-II) A and B lesions. However, the outcomes of self-expanding covered stents (SECSs) for extensive aortoiliac lesion remain unclear. This study aimed to assess the short-term patency of kissing covered stents for the revascularization of aortoiliac TASC-II C and D diseases. Methods: Thirty-three patients with TASC-II C and D lesions of AIOD were treated with kissing covered stents. All patients were reviewed under a standard institutional review board protocol. Demographic variables, lesion location and characteristics, stenting configuration, and patency were analyzed.Results: Thirty-one male and 2 female patients with a mean age of 65.1 ± 10.7 years underwent aortoiliac bifurcation reconstruction with kissing SECSs. Eight patients had TASC-II C lesions, and 25 patients had TASC-II D lesions. Among them, 8 patients had total infrarenal aortoiliac occlusion, of which 5 had juxtarenal aortoiliac lesions. The mean lesion length was 11.6 ± 2.1 cm. Mean diameters of aorta and common iliac artery were 18.3 ± 2.1 and 10.7 ± 1.5 mm, respectively. Among them, the abutting stent configuration was used in 11 patients with short or focal ostial lesions, whereas the crossing stent configuration was used in 22 patients with longer lesions extending into the distal aorta. The mean follow-up was 24.5 ± 7.8 months, the follow-up rate was 93.9% (31 of 33), and 29 patients had follow-up longer than 12 months. Primary patency rate at 12 months was 96.5%, and secondary patency rate was 100%. Conclusions: The use of kissing SECSs for the revascularization of extensive AIOD is safe and effective. The short-term primary patency rates of endovascular treatment of TASC-II C and D lesions were favorable.

Editor's Choice – Covered vs. Bare Metal Stents in the Reconstruction of the Aortic Bifurcation: Early and Midterm Outcomes from the COBRA European Multicentre Registry

“…16 Kissing iliac stents are associated with acceptable patency rates, comparable in some cases with open surgery; however, no high quality randomised controlled trials comparing open vs. endovascular AIOD reconstructions are available. 17,18 Furthermore, a variety of novel endovascular therapeutic approaches have been reported for AIOD, involving the use of both covered and bare metal stents in the aorta or iliacs. The Covered vs.…”

Treatment of Aortoiliac Occlusive Disease With the Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) Technique: Results of a UK Multicenter Study

“…19 Studies reporting on the use of kissing stents have demonstrated acceptable mid-and long-term patency. 20,21 The Covered versus Balloon Expandable Stent Randomised Trial (COBEST) also showed acceptable patency rates in the context of AIOD and a benefit when a covered stent was used in TASC C and D lesions. 22,23 Further studies have shown that using covered iliac stents for TASC C and D lesions is associated with favorable technical success, hence this is becoming a common technique to address AIOD.…”

“…22,23 Further studies have shown that using covered iliac stents for TASC C and D lesions is associated with favorable technical success, hence this is becoming a common technique to address AIOD. [6][7][8]10,[21][22][23][24] When using kissing stents in severe AIOD, however, the positioning of the stents and the discrepancy between the stented lumen and the aortic lumen ("radial mismatch") can have a negative impact on patency. 7,10,22 The CERAB technique aims to minimize this radial mismatch and achieve a more "anatomical" distal aortic and iliac reconstruction.…”

Treatment of Aortic and Iliac Artery Occlusion by Catheter Thrombolysis Combined with Catheter Thrombectomy and Aortic Bifurcation Endovascular Stent Reconstruction

“…We used a 14 mm balloon instead of a thrombectomy catheter and successfully removed the aortic-iliac artery thrombus. Considering that the patient had long aortic-bilateral iliac artery stenosis, we used CERAB [ 8 ], a technique with a high medium- and long-term patency rate in the reconstruction of complex AIOD [ 9 , 10 ]. After bilateral femoral artery angiography, the path map was made to determine the opening of the bilateral internal iliac artery, after which the bilateral common iliac artery stent was implanted into the lower segment of the abdominal aorta.…”