title: Early and midterm results of kissing stent technique in the management of aortoiliac obstructive disease.
abstract: BACKGROUND
  To retrospectively analyze the early and the midterm results of endovascular management of aortoiliac obstructive disease with the kissing stent technique.
  
  
  METHODS
  From January 2005 to September 2012, 229 consecutive endovascular interventions for aortoiliac obstructive disease were performed; data from all the interventions were prospectively collected in a dedicated database. In 41 patients, the kissing stent technique at the level of aortic bifurcation was performed (group 1), whereas in the remaining 188 it was not (group 2). Perioperative results were compared with chi-squared test. Follow-up results were analyzed with Kaplan-Meier curves and compared with log-rank test.
  
  
  RESULTS
  Trans-Atlantic Inter-Society Consensus II C and D lesions were present in 66% of patients in group 1 and in 28.5% in group 2 (P < 0.001), whereas iliac occlusion rather than stenosis was detected in 78% of patients in group 1 and in 50% in group 2 (P = 0.001). The mean number of placed stents was 2.5 in group 1 and 1.4 in group 2 (P < 0.001). Technical success was 100% in group 1 and 98% in group 2 (P = 0.3). The rate of perioperative complications was 7.3% in group 1 and 4.2% in group 2 (P = 0.4). At 30 days, neither deaths nor major cardiovascular complications occurred. There was no thrombosis or significant restenosis at the early postoperative follow-up visit. Mean duration of follow-up was 22 months. Primary patency rates at 4 years were 70.5% (standard error [SE], 0.09) in group 1 and 75.5% (SE, 0.06) in group 2 (P = 0.7). At the same interval, assisted primary and secondary patency and survival rates were also similar; reintervention rates were 15.5% in group 1 (SE, 0.1) and 19.5% in group 2 (SE, 0.06; P = 0.6).
  
  
  CONCLUSIONS
  The kissing stent technique provided satisfactory results in patients with obstructive aortoiliac diseases, without an increase in immediate and midterm complications, representing an effective solution in complex anatomies.
authors.affiliation: Department of Vascular Surgery, University of Florence, Florence, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Pulli
authors.affiliation: Department of Vascular Surgery, University of Florence, Florence, Italy. Electronic address: dorigow@unifi.it.
authors.forename: Walter
authors.initials: W
authors.lastname: Dorigo
authors.affiliation: Department of Vascular Surgery, University of Florence, Florence, Italy.
authors.forename: Aaron
authors.initials: A
authors.lastname: Fargion
authors.affiliation: Department of Vascular Surgery, University of Bari, Bari, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Angiletta
authors.affiliation: Department of Vascular Surgery, University of Florence, Florence, Italy.
authors.forename: Leonidas
authors.initials: L
authors.lastname: Azas
authors.affiliation: Department of Vascular Surgery, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pratesi
authors.affiliation: Department of Vascular Surgery, University of Florence, Florence, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Alessi Innocenti
authors.affiliation: Department of Vascular Surgery, University of Florence, Florence, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Pratesi
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000503:physiopathology; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency