Endovascular treatment of atherosclerosis at the aortoiliac bifurcation with kissing stents or distal aortic stents: a temporary solution or durable improvement?

To evaluate medium-term technical and clinical success after endovascular treatment of stenosis or occlusion at the aortoiliac bifurcation with a distal aortic stent or kissing stents. Between 1995 and 2004, 25 patients were included in the study. Nine patients were treated with an aortic stent, and 16 patients were treated with kissing stents. Clinical and radiologic findings were retrospectively reviewed, and statistical analysis was performed. In all cases, the procedure was technically successful. Hemodynamic success was observed in 22 patients (88%), and clinical success was observed in 23 patients (92%). After a median follow-up of 21 months, 8 patients developed a restenosis (n = 6) or occlusion (n = 2). Two patients with restenosis were treated successfully with aortic bifurcation grafts, and 4 patients underwent endovascular reintervention. No risk factors for restenosis were identified. Primary patency was 87% after 1 year and 65% after 2 years. Secondary patency was 90% after 1 year and 72% after 2 years. At the last outpatient control, 22 patients (88%) were free of symptoms. Endovascular treatment of symptomatic aortoiliac atherosclerosis at the aortoiliac bifurcation by means of a distal aortic stent or kissing stents can be used successfully with durable improvement in the majority of patients. We recommend it as the initial treatment modality.