Treatment for aortoiliac bifurcation disease by balloon-expandable covered stent; "Double-D" molding technique

Appropriate endovascular treatment for aortic bifurcation lesions remains unclear. Incomplete apposition and radial mismatch have not been resolved to date. We treated two cases of aortic bifurcation lesions including common iliac aneurysms with balloon-expandable covered stents with "Double-D molding technique (DDMT)." This is the method. First, standard kissing stent technique with two balloon-expandable covered stents for aortic bifurcation lesions is performed. Second, either covered stent post-dilated with a larger size percutaneous transluminal angioplasty (PTA) balloon before the other covered stent also post-dilated with the same larger size PTA balloon. Kissing balloon technique was performed with the two previous size PTA balloons. Good double-D shape configuration is observed. This DDMT could improve the radial mismatch of the kissing covered stents to distal aortic wall. 〈Learning objective: The treatment of aortoiliaic bifurcation disease including iliac aneurysms with balloon expandable covered stents using "double D-shape molding technique" is safe and effective.〉.