This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Scheinert, D. Articles by Biamino, G. Search for Related Content PubMed PubMed Citation Articles by Scheinert, D. Articles by Biamino, G. Pubmed/NCBI databases Medline Plus Health Information Angioplasty Related Collections Peripheral vascular disease Catheter-based coronary and valvular interventions: other Catheter-based coronary interventions: stents

(Circulation. 1999;100:II-295.)
© 1999 American Heart Association, Inc.

Aortic and Peripheral Vascular Surgery

Stent-Supported Reconstruction of the Aortoiliac Bifurcation With the Kissing Balloon Technique

Dierk Scheinert, MD; Malte Schröder, MD; Jörn O. Balzer, MD; Hermann Steinkamp, MD; Giancarlo Biamino, MD

From the Department of Medicine II, Cardiology, University of Erlangen-Nürnberg, Erlangen, Germany (D.S.); the Departments of Medicine, Nephrology and Intensive Care Medicine (M.S.), and Radiology (J.O.B., H.S.), Charitè, Campus Virchow Klinikum, Humboldt University, Berlin, Germany; and Center for Cardiology and Vascular Intervention (G.B.), Hamburg, Germany.

Correspondence to Dierk Scheinert, MD, Medizinische Klinik II mit Poliklinik, Universität Erlangen-Nürnberg, Ösliche Stadtmauerstrasse 29, 91054 Erlangen, Germany.

Background—Bilateral iliac artery obstructions involving the aortic bifurcation or high-grade stenosis of the abdominal aorta are not usually considered an indication for percutaneous treatment. The purpose of the present study was to evaluate the initial and long-term results of primary stent implantation for reconstruction of the aortic bifurcation.

Methods and Results—In 48 patients with obstructions of the aortoiliac segment, primary stent implantation was performed with the "kissing balloon technique." Preinterventional angiography showed bilateral stenoses (>85%) of the proximal common iliac arteries in 25 patients, unilateral occlusions and contralateral stenosis in 22 patients, and bilateral occlusion in 1 patient. In 7 cases, stents were placed for the treatment of high-grade infrarenal aortic stenoses. After excimer laser–assisted recanalization of the common iliac artery obstructions, the aortic bifurcation was reconstructed with the bilateral simultaneous implantation of Palmaz stents (diameter, 7 to 8 mm). Stents used for the treatment of aortic stenoses (Palmaz, n=6; Gianturco, n=1) had a diameter ranging from 20 to 25 mm. In all patients, stents were placed successfully (residual stenosis <30%) and without complications. A clinical improvement of +2 to +3 according to American Heart Association criteria was observed in 41 and 7 patients, respectively. Follow-up was performed clinically (standardized treadmill testing and color-coded Doppler ultrasound) and angiographically. The primary angiographic patency rate (24-month follow-up) was 86.8%. In 3 patients, angiography revealed significant restenoses, which were successfully treated with percutaneous transluminal angioplasty.

Conclusions—Primary stent implantation with the kissing balloon technique is safe and effective for the treatment of aortoiliac obstructions involving the aortic bifurcation and represents a true endovascular alternative to surgery.

Key Words: angioplasty • aorta • claudication • peripheral vascular disease • stents