"Staged" kissing stent placement under computed tomographic angiography guidance for a bilateral aortoiliac occlusion

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Medical Imaging

Background:

• Bilateral intermittent claudication is a common symptom of peripheral artery disease.
• Severe calcified aortoiliac occlusions pose a significant challenge for endovascular treatment.
• Patients with chronic kidney disease on hemodialysis often have complex vascular pathologies.

Purpose of the Study:

• To describe a case of successful kissing stent placement for bilateral aortoiliac occlusions.
• To evaluate the utility of computed tomographic angiography (CTA) in guiding percutaneous peripheral intervention for complex lesions.

Main Methods:

• A 64-year-old female patient on chronic hemodialysis presented with worsening bilateral intermittent claudication.
• Computed tomographic angiography (CTA) revealed severe calcified bilateral aortoiliac occlusions.
• A staged kissing stent placement technique was employed using SMART stents, guided by CTA.

Main Results:

• Successful placement of two parallel SMART stents (10 x 60 mm each) in the aortoiliac lesions.
• CTA clearly identified the penetrating point in the heavily calcified plaque, facilitating precise stent deployment.
• The intervention successfully addressed the patient's bilateral intermittent claudication.

Conclusions:

• Kissing stent placement is a viable treatment option for severe, calcified bilateral aortoiliac occlusions.
• CTA is a valuable tool for pre-procedural planning and intra-procedural guidance in complex percutaneous peripheral interventions.
• This case highlights the effectiveness of CTA-guided endovascular repair in managing challenging vascular disease in hemodialysis patients.