Unilateral Common Iliac Artery Ostial Lesion Stenting versus Kissing Stenting

INTRODUCTION

Iliac arteries are most common sites of the occlusive atherosclerotic disease that is responsible for symptomatic arterial insufficiency of lower extremities.¹ Iliac atherosclerosis may be asymptomatic or presented by acute ischemia, intermittent claudication, critical limb ischemia (CLI).² The advancing role of the minimal invasive vascular intervention is affected by multiple factors, including imaging technology advancement, reduced morbidity & mortality rate in endovascular interventions, as well as faster convalescence following percutaneous therapy when compared to surgery.³ Due to low morbidity and mortality rates in iliac angioplasty, become a  option to bypass surgery for treatment of short iliac occlusive lesions.⁴ The Trans Atlantic Inter-Society Consensus (TASC) has published a consensus document with recommendation for treatment of peripheral arterial diseases.⁵ The TASC classify iliac artery lesions according to complexity to Type A, B, C& D lesions. Endovascular therapy is the best choice for type A lesions and surgery is preferred for type D lesions.⁵ Lesions at the orifice of the common iliac artery at aortic bifurcation have another considerations as intervention on one iliac may lead to affect of origin of other iliac by moving of eccentric plaque so using of the kissing stent technique protect the other iliac origin.⁶

This work aimed to assess using of unilateral common iliac artery stent versus kissing stent as regard clinical and technical success in unilateral ostial common iliac artery lesions.

PATIENTS AND METHODS

In this prospective study from December 2018 to December 2020 in Al-Azhar University Hospital and Military Hospitals in Cairo, we assigned 20 patients with unilateral ostial iliac lesion underwent either unilateral stent or kissing stenting; 10 patients in each group. Patients were followed for type of technical, clinical success and complications.

Inclusion criteria: Patient  (male &female) with, unilateral ostial iliac artery lesion, disabling claudication pain not respond to medical treatment or have tissue loss or gangrene.

Exclusion criteria: Patients with short life expectancy or terminal patient, Previous stent implantation in the target vessel or Known hypersensitivity to contrast material or Renal function impairment or Patient with an abdominal aortic or iliac aneurysm.

For every patient, the following were required: Medical history and full physical examination, laboratory tests (complete blood count,  complete coagulation profile, and kidney function test), and computed angiography .

RESULTS

Statistical Analysis:

Data entry, process with statistically analysis was carried out by MedCalc ver. 18.2.1 (MedCalc, Ostend, Belgium). Significant tests (Mann-Whitney’s, Chi square tests, logistic regression analysis and Spearman’s correlation) were used. Data presented and analysis was done according to the type of data (parametric and non-parametric) obtained for each variable. P-values less than 0.05 (5%) was considered to be statistically significant.

Discriptive statistics:

Mean, Standard deviation (± SD) and range numerical data, while Median and Inter-quartile range (IQR) non-parametric data. Frequency and percentage of non-numerical data.

Analytical statistics:

Mann-Whitney's Test (U test) used to evaluate the statistical significance of the difference of a non-parametric variable between two study groups. Chi-Square test was used to assess the relationship between two qualitative variables. Correlation analysis (using Spearman's method): To assess the strength of association between two quant (itative variables. The correlation coefficient denoted symbolically "r" defines the strength and direction of the linear relationship between two variables. Logistic regression: useful in the prediction of the presence or absence of an outcome based on a set of independent variables.

Table 1 shows that there is 16 (80%) males, 4 (20%) females, 9 (45%) 60 years old, the mean of age 61.35 (± 6.57 SD).

Regarding comorbidities, Table 2 shows that there is 16 (80%) had HTN, 7 (35%) had hyperlipidemia, 8 (40%) had DM and 8 (40%) had IHD.

Table 3 shows that there is 4 (20%) non-smokers and 16 (80%) smokers.

Table 4 shows that ipsilateral and contralateral femoral access used in 16 (80%) of cases and left brachial access and contralateral femoral access used in 4 (20%).

Table 1: Distribution according to demographic data (n = 20) (IQR: Inter quartile range).

Table 2: Distribution according to co-morbidity (n = 20).

Table 3: Distribution according to special habits (n = 20).

Table 4: Distribution according to access (n = 20).

Table 5 shows difference between pre-operative and post-operative ABPI.

Table 6 shows that according to complication there is 3 (15%) had groin heamatoma, 1 (5%) had distal embolization, 1 (5%) had arterial dissection, 1 (5%) had contrast induced nephropathy CIN.

Table 7 shows that according to technical success there is 20 (100%) had complete angiography without residual stenosis denote technical success and 20 (100%) had pressure gradient by duplex less than 10 mmHg.

Table 8 shows that is no significant difference between Unilateral and kissing techniques as regards follow up by duplex.

Table 5: Comparison between the pre and post-operative ABPI:

Table 6: Distribution according to complications (n = 20)

Table 7: Distribution according to technical success (n = 20)

Table 8: Relation between technique and follow up by duplex (n = 20)