A Novel Approach to Aortoiliac Bifurcation Stenting Using a Single Balloon-Expandable Stent

J INVASIVE CARDIOL 2019;31(1):E8.

Key words: aortoiliac disease, bare-metal stent, limb ischemia

Received wisdom for aortoiliac bifurcation stenting typically dictates the kissing-stent approach using two stents even if critical disease is limited to one side in order not to compromise the contralateral common iliac ostium (CIO). We hypothesized that when critical disease is limited to just one CIO and the contralateral CIO is relatively disease free, one can get away with a single balloon-expandable stent straddling the diseased CIO if the contralateral CIO is protected with a simultaneous matching balloon inflation.

Five patients with a mean age of 65 years were identified; 60% were males, diabetic, and smokers. All patients had disabling unilateral hip and thigh claudication. They underwent stenting of diseased CIO with bare-metal stent while the contralateral CIO was protected with matching balloon inflation. Mean stent diameter and length were 7.8 mm and 46 mm, respectively. Mean matching balloon diameter and length were 7.4 mm and 32 mm, respectively. All target and contralateral CIOs were approached from the ipsilateral common femoral artery (CFA) except one non-diseased CIO, which was approached from the left axillary artery due to severe CFA disease. There were no procedural complications. Non-target CIO remained uncompromised in all cases. All patients went home the next morning and were symptom free at 1 month.

Contrary to received wisdom, predominantly unilateral aortoiliac bifurcation disease can be safely treated with a single stent if the contralateral CIO is protected with matching balloon inflation. Larger studies on this novel approach with a longer clinical follow-up are needed to validate our results.

From the Department of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted July 24, 2018. 

Address for correspondence: Najam Wasty, MD, FACC, Director, Cardiac Catheterization Lab, Newark Beth Israel Medical Center, 201 Lyons Avenue at Osborne Terrace, Newark, NJ 07112. Email: najam.wasty@rwjbh.org