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Kissing Stents In The Aortic Bifurcation - An Acceptable Alternative To Open Surgery Irrespective Of TASC Classification

Katarina Björses¹, Krassi Ivancev², Lorenzo Riva³, Jonas Manjer⁴, Timothy Resch.^1
1Department of Vascular Diseases, Malmö, Sweden; ²Endovascular Centre, Malmö, Sweden; ³Department of Surgery, Kristianstad, Sweden; ⁴Department of Surgery, Malmö, Sweden.

OBJECTIVES: To evaluate the long-term results and factors predicting outcome of stent treatment of TASC A-D lesions affecting the aortic bifurcation.

METHODS: Patients treated with aortoiliac kissing stents between 1995 and 2004 at a tertiary hospital were identified through local databases. Review of charts and preoperative images were used for TASC and Fontaine classification and SVS-ISCVS runoff scores. Patients were followed with clinical exams, ABI and/or duplex. Patency rates were estimated by Kaplan-Meier, and Cox multivariate regression analyses were used to determine factors affecting patency.

RESULTS: 173 consecutive patients (mean 64 years, 54% female) were identified. During the study period only 3 patients underwent primary open aortobifemoral grafting. TASC distribution was: A 15%, B 34%, C 10%, D 41%. The infrarenal aorta was occluded in 11 patients (6 %). Mean follow-up was 34 months (range: 1-130). 30-day mortality was 1% (2 pat), and 1-year survival was 91% (157 pat). 2 patients underwent late, open conversion. 13 patients suffered minor puncture site complications. Primary and secondary patency rates are presented in table I.There was no significant difference in patency between the TASC groups. Patency was significantly worse in patients with Fontaine class III.

CONCLUSIONS: Aortoiliac kissing stents is a valid alternative to standard open repair for TASC A-D lesions. The procedure has low mortality and morbidity and good patency at 3 years.