Abstract:

Objectives: This study aims to compare the outcomes of self-expanding stents (SESs), bare balloon expandable stents (BESs), and covered stents (CSs) in the kissing stent (KS) treatment of aortoiliac bifurcation (AIB) lesions and to identify the predictors of in-stent restenosis (ISR) development. Patients and methods: Between January 2012 and December 2018, a total of 123 patients (108 males, 15 females; mean age: 62.4±9.1 years; range, 37 to 85 years) who had primary KS reconstruction of AIB for symptomatic aortoiliac occlusive disease (AIOD) were retrospectively analyzed. There were 31 patients in the SES group, 56 patients in the BES group, and 36 patients in the CS group. Technical and clinical success, intra- and perioperative complications, determinants of ISR and patency rates were documented. Results: Technical success was achieved in 99.2% of the patients. Clinical symptom improvement was achieved in all three groups (ABI, p=0.45; Rutherford, p=0.35). Median follow-up was 35 (range, 22.5 to 50) months. Primary patency at one and five years were 100% and 82%, respectively for SES, 98% and 88%, for BES, and 92% and 85% for CS (p=0.53). Regression analysis revealed a longer aortic stent length (hazard ratio [HR]: 5.94, 95% confidence interval [CI]: 1.34-26.25, p=0.035) to be significant determinants of ISR. The receiver operating characteristic curve identified 15-mm as the cut-off value with an area under the curve of 0.644. Primary patency rates for <15-mm aortic stent length were 100% and 88% at 12 and 60 months, respectively (p=0.028). Conclusion: The use of SES, BES, and CS for KS treatment of AIB offers favorable and compatible long-term patency with aortic stent length being an independent factor affecting ISR.

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