KISSING STENT TECHNIQUE FOR AORTO-ILIAC OCCLUSIVE DISEASE: 5-YEAR FOLLOW UP | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 32, Issue 2, April 2013, Page 109-115 PDF (1.99 MB) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejsur.2013.366743 | ||||
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| Authors | ||||
Engie T. Hefnawy; Karim A. Hosny; Fouad Saad El-Dien; Samy Khalifa; Amr Gad 
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| Department of General Surgery, Cairo University, Egypt | ||||
| Abstract | ||||
| Occlusive disease of the aorta and iliac arteries may lead to incapacitating claudication or, critical limb ischemia. Until recently, symptomatic stenoses or occlusions at the aortoiliac bifurcation were generally treated surgically with aorto-bi-femoral grafts. However, although these interventions are highly effective (5-year patency rate of more than 91%), they are also associated with significant morbidity (8.3%) and mortality (3.3%). As an alternative to surgical treatment, endovascular intervention deploying percutaneous transluminal angioplasty with placement of aortoiliac kissing stents has been introduced to treat aorto-iliac occlusive disease. The aim of this study is to show the results of 5-year follow up of cases treated with the Kissing stent technique, done between June 2006 and May 2008, as regards primary and secondary patency rates, clinical improvement, ABI, complications (and how managed) and mortality. The study included sixty-two patients; twelve of them with TASC A(19.3%), thirty three with TASC B (53.3%), and seventeen selected cases of TASC C (27.4%)(those not extending to or involving the common femoral artery). Five-year primary and secondary patency rates were 71% and 81%, respectively. Hemodynamically significant restenosis developed in nine patients (14.5%). The management of restenosis was endovascular in eight patients and was successful in all (balloon dilation-PTA alone- in four, dilataion and restenting in the other four) and operative in one patient who developed aortic occlusion and underwent aortobifemoral grafting. Seven cases (11.3%) were totally occluded; 3 redilated and 4 operated upon. Most common intra-procedural complications were, access site hematomas distal embolization, and arterial dissections. The majority of complications could be treated using percutaneous or noninvasive techniques, only one case of thrombosis required urgent Aorto-bi-femoral bypass. One patient had major amputation due to distal disease and with patent stents. Conclusion: Endovascular treatment of extensive AIOD can be performed successfully in TASC A, B and selected patients of TASC C. Although primary patency rates are lower than those reported for surgical revascularization, reinterventions can often be performed percutaneously, with secondary patency fairly comparable to surgical repair. TASC D and TASC C with involvement of CFA should be primarily treated surgically. | ||||
| Keywords | ||||
| Endovascular; arterial occlusive disease; abdominal aorta; iliac artery; Le riche syndrome; angioplasty; kissing stent | ||||
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