Valve-Like and Protruding Calcified Intimal Flap Complicating Common Iliac Arteries Kissing Stenting.

George S Georgiadis,Christos C Argyriou,Miltos K Lazarides,George A Antoniou,Efstratios I Georgakarakos,Nikolaos Schoretsanitis

doi:10.1155/2015/451962

Abstract

Endovascular therapy for iliac artery chronic total occlusions is nowadays associated with low rates of procedure-related complications and improved clinical outcomes, and it is predominantly used as first-line therapy prior to aortobifemoral bypass grafting. Herein, we describe the case of a patient presenting with an ischemic left foot digit ulcer and suffering complex aortoiliac lesions, who received common iliac arteries kissing stents, illustrating at final antegrade and retrograde angiograms the early recognition of a blood flow obstructing valve-like calcified intimal flap protruding through the stent struts, which was obstructing antegrade but not retrograde unilateral iliac arterial axis blood flow. The problem was resolved by reconstructing the aortic bifurcation at a more proximal level. Completion angiogram verified normal patency of aorta and iliac vessels. Additionally, a severe left femoral bifurcation stenosis was also corrected by endarterectomy-arterioplasty with a bovine patch. Postintervention ankle brachial pressure indices were significantly improved. At the 6-month and 2-year follow-up, normal peripheral pulses were still reported without intermittent claudication suggesting the durability of the procedure. Through stent-protruding calcified intimal flap, is a very rare, but existing source of antegrade blood flow obstruction after common iliac arteries kissing stents.

Highlights

Aortobifemoral bypass is still considered the gold standard treatment for chronic total occlusions (CTOs) of iliac arteries that belong to Transatlantic Intersociety Consensus (TASC II) guidelines C/D lesions [1]
We describe the case of a patient presenting with an ischemic left foot digit ulcer and suffering left common iliac artery (CIA) CTO and contralateral CIA severe stenosis, who received CIA kissing stents
A severe left femoral bifurcation stenosis was corrected by endarterectomy-arterioplasty with a bovine patch

Summary

Introduction

Aortobifemoral bypass is still considered the gold standard treatment for chronic total occlusions (CTOs) of iliac arteries that belong to Transatlantic Intersociety Consensus (TASC II) guidelines C/D lesions [1]. Recent studies using bare metal stents in the common iliac arteries (single or bilateral with an overlap in the distal aorta) for the treatment of bilateral aortoiliac occlusive disease have demonstrated a high rate of technical success, good mid- and long-term patency, and low procedural morbidity and mortality [3, 4, 6,7,8]. This is more prominent when primary stenting is performed instead of transluminal angioplasty followed by selective stenting [9]. Retrograde left iliac axis blood flow, and necessitating the reconstruction of the aortic bifurcation at a more proximal level

Case Presentation

Discussion

Conclusion