Outcome of iliac kissing stents.

Abstract

Introduction ‘‘kissing stent’’ insertion. All procedures were performed electively in patients with proximal common Angioplasty, with or without stenting, is increasingly iliac lesions, in whom it would not have been possible to place a stent without it protruding into the aorta. used to treat patients with symptomatic aorto-iliac occlusive disease. In patients with intermittent clauClinical indications included bilateral claudication (6 patients), unilateral claudication (3 patients), claudidication or critical limb ischaemia due to unilateral or bilateral common iliac artery (CIA) origin stenosis cation and contralateral rest pain and tissue loss (1 patient), unilateral rest pain and tissue loss (1 patient). and/or occlusion the ‘‘kissing balloon’’ technique has been advocated. In the largest reported series of 79 Thus, 16 limbs were affected by claudication and 4 by critical limb ischaemia. Four stents were placed in a patients, Insall described the technique as effective and durable. However, in this and another series there contralateral asymptomatic common iliac artery (Table 1), 1 was normal and the remainder had stenoses of was a significant incidence of dissection, thrombosis and residual stenosis. It has been suggested that 46%, 50% and 82%. The median (range) symptomatic of common iliac stenosis was 60% (50–95%) and the simultaneous bilateral placement of common iliac artery stents to refashion the aortic bifurcation, the sothree occlusions were 4, 35 and 44 mm in length. A variety of stents Palmaz (Cordis, Johnson & Johnson), called ‘‘kissing stents’’ technique, might reduce the incidence of these complications. To date, the two Symphony (Boston Scientific), Memotherm (Baird) and published series have reported favorable initial results Bridge stent (Medtronic) were used. Only one limb although follow-up has been short. The aim of this had more than one stent inserted. Post-procedurally study was to examine our experience with the ‘‘kissing 10 patients were maintained on aspirin and 2 on stents’’ technique in terms of procedure related morwarfarin. bidity and medium term haemodynamic and clinical Downstream angiographic lesions were present in 7 patency. Kissing stents have been defined as bilateral limbs as follows: external iliac (n=1), common femoral common iliac stents which extend into the aorta such (n=1), superficial femoral (n=1), profunda femoris that the two adjacent stent walls come into apposition (n=1), popliteal/crural (n=5). One patient had an for at least one cm in the native aorta. external iliac artery angioplasty. Major morbidity in 2 patients comprised: unilateral distal embolisation treated by means of aspiration and thrombolysis and a surgically repaired common femReport oral pseudo-aneurysm. One further patient had a delayed hospital discharge due to the development of Between 1993 and 1998, 5 males and 7 females, median bilateral iliac dissections which were treated with hep(range) age of 62 (43–73) years, underwent planned arin. All patients reported an immediate Rutherford ∗ Please address all correspondence to: A. W. Bradbury, Professor +2 or +3 improvement in their symptoms (Table 1). of Vascular Surgery, University Department of Surgery, Lincoln Patients were followed up in a dedicated House (Research Institute), Birmingham Heartlands Hospital, Bordersley Green East, Birmingham B9 5SS, U.K. clinic, clinical and haemodynamic outcomes were