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Monday, June 8, 2015

Covered Stents in Use of Kissing Iliac Lesions

Atherosclerotic occlusive disease involving the aortic bifurcation has historically been treated with surgical bypass; however endovascular treatment with the “kissing” stent technique is now considered a durable alternative treatment option. The aim of this retrospective review was to describe the performance of kissing covered balloon expandable stents (CBES) for aortoiliac occlusive disease at the level of the aortic bifurcation after a follow-up of up to 4 years. During the study time period, 73 kissing CBES procedures were performed, 42 primary procedures and 31 secondary procedures after prior endovascular interventions (excluding 4 patients previously treated with CBES). Primary outcomes were primary patency and freedom from target lesion reintervention (TLR), with loss of primary patency defined as a CBES that occluded, a CBES with restenosis or that required reintervention. Secondary outcomes were secondary patency, clinical improvement, and mortality. 22 TASC A, 21 TASC B, three TASC C and 23 TASC D lesions were treated with the kissing stent technique. Duplex ultrasound follow up examination was available for 51 patients at 1 year, 41 patients at 2 years, and 25 patients at 4 years. Primary patency was 88.1% at 1 year, 78.8% at 2 years and 71.5 % at 4 years, with loss of primary patency primarily occurring due to occlusion in 78% of the cases. Secondary patency rates were 88.1% at 1 year, 82.8% at 2 years and estimated secondary patency was 75.3% at 4 years. Freedom from TLR was 92.4% at 1 year and 76.5% at 4 years. While both primary and secondary patency rates were improved in the primary stent placement group compared to the reintervention group, this was not found to be significant at univariate analysis.

Comment: 
Although retrospective in design and with a limited number of patients available for follow up out to the 4 year time period, the results are comparable to other similar cohort studies and show satisfactory patency rates within 4 years of intervention. Also noteworthy is the improved primary and secondary patency rates demonstrated for primary stent placement compared to secondary stent placement.


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Kaplan-Meier survival curves showing patency rates and target lesion revascularization.


Citation: Grimme, F. A. B., Spithoven, J. H., Zeebregts, C. J., Scharn, D. M. & Reijnen, M. M. P. J. Endovascular Treatment of Occlusive Lesions in the Aortic Bifurcation with Kissing Polytetrafluoroethylene Covered Stents. Journal of Vascular and Interventional Radiology (2015). doi:10.1016/j.jvir.2015.04.007


Post author: Jamie Doster MD, Radiology Resident, University of Virginia

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