Biomedical subjects

D Scheinert

Publications and source records attributed to D Scheinert.

At least 19 recordsLinked to original sources

PubMed2005

Percutaneous transluminal angioplasty for renovascular hypertension in a neonate.

AIM: To report on the first case of successful percutaneous transluminal renal artery angioplasty in a neonate. METHODS CASE REPORT: a 5-d-old neonate was admitted with cardiorespiratory failure. Monitoring of blood pressure revealed severe arterial hypertension. Doppler sonography detected stenotic flow in the right renal artery. A (99m)Tc-MAG3 scan revealed highly diminished elimination by the right kidney. Selective renin levels were 23,968 ng/l in the right and 3770 ng/l in the left renal vein and the aorta. Percutaneous transluminal angioplasty using a 2 x 10 mm balloon catheter was performed on the 8th day of life. RESULTS: The patient was discharged from hospital normotensive without anti-hypertensive medication. During 8 mo follow-up the blood pressure remained normal, Doppler sonography revealed no recurrent artery stenosis, and renal function improved. CONCLUSION: Neonatal percutaneous transluminal angioplasty for renal artery stenosis may be feasible in selected patients.

Angiography↗

PubMed2004

Endoluminal stent-graft placement for acute rupture of the descending thoracic aorta.

AIMS: To investigate the results of endovascular stent-graft placement for the treatment of acute perforating lesions of the descending thoracic aorta. METHODS AND RESULTS: A total of 31 consecutive patients underwent interventional treatment for perforating lesions of the descending aorta. In 21 cases (group A), the aortic perforation was due to rupture of a descending thoracic aneurysm or dissection, whereas 10 patients (group B) were treated for traumatic transection of the descending aorta. A total of 42 endoprostheses were implanted. The implantation procedure was successful in all cases without peri-interventional complications. In one case, implantation of a second endoprosthesis became necessary due to type I endoleak. Overall, the 30-day mortality was 9.7%. As all three deaths occurred in group A, the mortality rate in this group was 14.3% versus 0% in group B. Similarly, postinterventional complications were more prevalent, with 28.6% in group A (renal failure n = 4; stroke n = 2) versus 10.0% in group B (renal failure n = 1). No paraplegia and no further deaths or ruptures occurred during follow-up (mean 17 months). CONCLUSION: Interventional stent-graft placement is an effective treatment option for the emergency repair of descending aortic perforations.

Acute Kidney Injury↗

PubMed2004

First clinical experiences with an endovascular clamping system for neuroprotection during carotid stenting.

OBJECTIVES: This report evaluates the feasibility and efficacy of an endovascular blood flow blockage technique to prevent intracerebral embolization of plaque debris during carotid artery stenting. METHODS: Forty-two patients were enrolled in five clinical sites in Germany and Italy with either an asymptomatic internal carotid artery stenosis > or =75% (mean 87%) or a symptomatic stenosis > or =60% (mean 85%). Cerebral protection during the stenting procedure was achieved using an endovascular clamping technique, obtained by occlusion of the external and common carotid artery via two independently inflatable balloons integrated in the Mo.Ma system. Blood with particulate plaque debris was aspirated before flow was restored. The patient's clinical and the neurological status were assessed during intervention, at discharge, and at 3 months follow-up. RESULTS: Stenting was performed in all but one patient. The mean flow occlusion time was 10.6+/-6.5 min. Transient clamping intolerance was observed in five patients (12%). In two patients, neurological deficits persisted for 2 and 12 h, respectively. Two minor strokes (4,7%) occurred at 5 and 72 h after the procedure. No major strokes or deaths were observed at 3 months follow-up. CONCLUSIONS: This first clinical experience with the Mo.Ma device substantiates the feasibility of endovascular clamping in preventing cerebral embolization during carotid artery stenting.

Carotid Artery, Internal↗

PubMed2004

Treatment of long superficial femoral artery occlusions with excimer laser angioplasty: long-term results after 48 months.

PURPOSE: To evaluate clinical and hemodynamical long-term results after laser angioplasty of long occlusions of the superficial femoral artery (SFA). MATERIAL AND METHODS: In a prospective trial of 452 patients with long occlusions of the SFA, excimer percutaneous transluminal laser angioplasty (PTLA) for recanalization was applied. The average occlusion length of the SFA was 25.5 cm (range 16-38 cm). The recanalization attempt was done with the crossover technique in 398 patients, in 36 patients with the antegrade technique and in another 18 patients with the transpopliteal technique. RESULTS: The application of laser angioplasty demonstrated a successful recanalization of the SFA in 386/452 patients (85.5%). Recanalization with PTLA was not possible in 66 patients (14.5%). The main reason for the unsuccessful PTLAs was obstructing calcified material (n = 28) resistant to PTLA application. After a follow-up period of 48 months there was a primary, primary-assisted, and secondary patency rate of 22.3%, 40.9%, and 43.2%, respectively. CONCLUSION: Laser angioplasty of long occlusions of the SFA is a feasible procedure with a low failure rate. Long-term results are promising, but additional interventions are required in most patients if a patency rate of 43.2% is to be achieved after 4 years.

Adult↗

PubMed2003

[Intra-arterial lysis therapy in acute limb ischemia. Technical possibilities and limits of indication].

Acute limb ischemia is associated with a high risk of death and loss of the extremity. To restore the blood flow, several percutaneous thrombolytic techniques were developed. To achieve a targeted thrombus infiltration, the continuous application of low-dose urokinase or recombinant tissue plasminogen activator using a specific lysis catheter with sideholes is preferable. Concerning the amputation-free survival, thrombolysis is superior to surgery for occlusions of native vessels or bypass grafts that are not older than 2 weeks. Furthermore, the percutaneous approach permits the simultaneous treatment of the underlying lesion by angioplasty or stent implantation after dissolution of the occluding thrombus. The higher risk of complications must be balanced against risks of surgery in each patient.

Acute Disease↗

PubMed2002

Short (1-10 cm) superficial femoral artery occlusions: results of treatment with excimer laser angioplasty.

PURPOSE: To evaluate the safety and long-term results after laser angioplasty of short occlusions of the superficial femoral artery (SFA). METHODS: In a prospective trial in 312 patients with short occlusions of the SFA excimer laser angioplasty for recanalization was applied. The average occlusion length of the SFA was 7.5 cm (range 1-10 cm). The recanalization attempt was done using either a cross-over technique from the contralateral femoral artery (278 patients), antegrade technique (16 patients) or transpopliteal technique (18 patients). RESULTS: Percutaneous transluminal laser angioplasty (PTLA) produced successful recanalization of the SFA in 286 of 312 patients (91.7%). In 26 patients (8.3%) recanalization was not possible. The reason for the unsuccessful PTLAs was obstructing calcified materialn = 8) which was resistant to laser application. In nine cases obstructing calcifications resulted in positioning of the laser catheter in subintimal tissue or perforation of the SFA. In another four patients there was an aberrant anatomy of the SFA which resulted in a direct vessel injury after advancing the laser catheter. In five patients subintimal recanalization failed. After a follow-up period of 36 months there was a primary, primary assisted and secondary patency rate of 49.2%, 76.5% and 86.3%. CONCLUSION: Excimer laser angioplasty of short occlusions of the SFA is a feasible procedure with a low failure rate. Long-term results are promising but additional interventions are required in most patients to achieve a patency rate of 86.3% after 3 years. Further studies are needed to compare the clinical outcome of PTLA and PTA in short occlusions of the SFA.

Angioplasty, Balloon, Laser-Assisted↗

PubMed2002

High-dose intravascular beta-radiation after de novo stent implantation induces coronary artery spasm.

BACKGROUND: Intracoronary brachytherapy is effective in preventing restenosis after coronary interventions. However, in vitro and animal studies have shown that irradiation produces immediate and sustained endothelial dysfunction. This study assesses the clinical relevance of impaired vasomotoric function induced by brachytherapy. METHODS AND RESULTS: We analyzed the occurrence of postradiation coronary artery spasms in 1 animal study and 2 clinical trials investigating the effects of high-dose intracoronary beta-radiation after de novo coronary artery stenting. Irradiated segments (IRSs) proximal and distal to the stent were studied by quantitative coronary angiography after stenting, after radiation, and at the end of the procedure. There was an 67% overall incidence of coronary artery spasm in the IRSs immediately after beta-radiation compared with 9% after sham treatment (P<0.001). Whereas in most cases this phenomenon was only minor or moderate, in 12 cases, 4 (22%) animals and 8 (28%) patients, severe coronary spasm (>90% diameter stenosis) with significant ECG-changes or hemodynamic instability was observed. Relief of spasms was protracted (mean time until complete relief of spasm 423+/-122 seconds) and required repetitive intracoronary administration of nitroglycerin (mean dose: 1.2+/-0.6 mg). CONCLUSIONS: Vasoconstriction is a frequent reaction of coronary arteries after high-dose intracoronary beta-radiation, necessitating repetitive administration of vasodilators.

Animals↗

PubMed2002

Initial experience with the Endicor X-sizer thrombectomy device in patients with ST segment elevation myocardial infarction.

We investigated 16 patients with ST segment elevation myocardial infarction who had an occluded coronary artery (TIMI 0) at initial angiogram. Instead of balloon angioplasty and stenting, patients were subjected to thrombectomy (Endicor X-sizer) and stenting. In 15/16 patients the occlusion could be crossed by the thrombectomy device resulting in TIMI flow 3 in all of them. Thereafter, stenting was performed. At final angiogram all 15 patients continued to show TIMI flow grade 3. Twelve-lead ECG was performed prior to and post-intervention. ST elevation was measured as the sum of eight leads for anterior infarction and of five leads for inferior infarction. In 13/15 patients, ECG analysis was possible (2 developed bundle branch block post-intervention). In all 13 patients, a > 50% ST decrease of the initial amount of ST elevation was observed reaching a > 70% reduction in 11 patients. Procedural complications were low (one coronary dissection after thrombectomy) and 30 days follow-up was uneventful. Thrombectomy using the Endicor X-Sizer device may become an attractive mechanical reperfusion strategy for patients with acute myocardial infarction.

Aged↗

PubMed2001

Stent-supported recanalization of chronic iliac artery occlusions.

PURPOSE: Iliac artery occlusions that are more than a few centimeters in length are normally treated with surgical bypass grafting. The aim of this study was to evaluate the results of primary stent implantation after Excimer laser-assisted recanalization of iliac artery occlusions. SUBJECTS AND METHODS: We studied 212 consecutive patients with chronic unilateral iliac artery occlusions (mean [+/- SD] length 8.9 +/- 3.9 cm) who were treated with Excimer laser-assisted recanalization and stent implantation. Based on the criteria of the Society of Cardiovascular and Interventional Radiology, lesions were graded as class III occlusions (<5 cm) in 46 patients and as class IV (> or =5 cm) in 166 patients. A total of 527 stents (Palmaz stent, 346; Wallstent, 94; Strecker stent, 38; covered stents, 49) were implanted. RESULTS: Technical success was achieved in 190 (90%) patients. There was a clinical improvement of three grades in 112 (53%) patients and of two grades in 67 (32%) patients. The rate of major complications was 1.4%, which included arterial rupture (1) and embolic events (2). Primary patency rates were 84% at 1 year, 81% at 2 years, 78% at 3 years, and 76% at 4 years. Secondary patency rates were 88% at 1 year, 88% at 2 years, 86% at 3 years, and 85% at 4 years. CONCLUSION: Stent-supported angioplasty is an effective treatment for iliac artery occlusions, with less morbidity and mortality than is associated with surgery. However, reported long-term patency rates after bypass surgery are greater than those we observed with interventional treatment. The value of primary stenting as compared with angioplasty alone should be evaluated in a randomized trial.

Arterial Occlusive Diseases↗

PubMed2001

Postinterventional transcutaneous suture of femoral artery access sites in patients with peripheral arterial occlusive disease: a study of 930 patients.

The purpose of this study was to evaluate a percutaneous vascular suture (PVS) device in patients with peripheral arterial occlusive disease (PAOD) for achievement of immediate hemostasis at the vascular access site and early ambulation of fully anticoagulated patients after peripheral interventional procedures. From June 1995 to March 2000, a vascular suture using a PVS device (6-10 Fr) was applied in 930 patients with PAOD. All patients had received an endoluminal intervention in the pelvic and/or the contralateral femoropopliteal region via a retrograde access through the common femoral artery (CFA). The incidence of complications within 12 hr after intervention, prior to discharge, and at 30-day follow-up was assessed employing clinical examination, treadmill test, and color Doppler ultrasound and the safety of the PVS device was determined. The efficacy of the system was measured by the percentage of achieved immediate hemostasis and early ambulation. PVS was technically successful in 92.2% independently from the degree of calcification at the access site. In 7.8%, an appropriate suture delivery could not be performed and these patients were successfully treated by conventional compression technique. Device malfunction or insufficient suture closure occurred in 1.7% and 2.1%, respectively. In 7.0%, groin-related complications occurred. Ambulation within 2-4 hr after successful suture was possible in 96.1%. All patients were free of any local symptoms at 30-day follow-up. The PVS device provides a safe and effective solution to achieve immediate hemostasis, thus permitting early ambulation in fully anticoagulated patients with PAOD after peripheral interventional procedures.

Arterial Occlusive Diseases↗

PubMed2001

Transradial approach for renal artery stenting.

Percutaneous interventional procedures in the renal arteries are usually performed using a femoral or brachial vascular access. The transradial approach, which has been extensively investigated for coronary angiography and intervention, could be an attractive new technique for renal artery angioplasty and stenting. In 18 patients with hemodynamically relevant unilateral renal artery stenosis (mean diameter stenosis, 83% +/- 18%; right, n = 7; left, n = 11), interventional treatment with PTA and stenting was performed using a left (n = 16) or right (n = 2) radial artery access. Indications for the transradial approach were acute aorto-renal angles or severe peripheral arterial obstructions. After engagement of the renal artery ostium with a 6 Fr Multipurpose guiding catheter (length, 125 cm; Cordis) the stenosis was passed with a 0.014" guidewire followed by stent implantation (ACS Multi-Link RX Ultra, Guidant; length, 18 mm; diameter, 5 mm). Direct stenting was successfully performed in 16 cases. Predilatations were required in two cases. In five patients, optimal stent expansion was achieved by additional postdilatations. A primary technical success (residual stenosis < 30%) could be achieved in all cases. There were no periprocedural complications. According to color-coded doppler ultrasound, all access site arteries showed a normal perfusion. Clinically blood pressure control was improved in 11 patients with a significant reduction in systolic and diastolic blood pressure values. Serum creatinine values dropped from 1.81 +/- 0.3 mg/dl to 1.49 +/- 0.3 mg/dl (P < 0.001). Transradial renal artery angioplasty and stenting is technically feasible and safe. Particularly in patients with unfavorable vessel anatomy, this new cranio-caudal approach is an attractive alternative technique.

Aged↗

PubMed2001

Continuous measurements of renal perfusion in pigs by means of intravascular Doppler.

BACKGROUND: Changes in renal blood flow are considered to play a significant role in the induction and maintenance of kidney failure, but are difficult to monitor with currently available techniques. The objective was to validate renal flow measurements with Doppler guidewires and to apply this technique to assess dose and time dependency of the renal vascular effects of norepinephrine (NE). METHODS: In 10 anesthetized pigs, flow velocity in renal arteries (FVart) and veins (FVvein) and volumetric renal blood flow (VBF) were measured before and after intravenous bolus application of incremental doses of NE (2 to 200 microg). RESULTS: FVart curves exactly reflected the changes in VBF. Beat-to-beat analysis revealed a strong linear correlation over a mean VBF range of less than 0.05 to 0.35 L/min (median correlation coefficient with FVart, r = 0.998), and significant but less close relationships were also found between VBF and FVvein. Ten seconds after the administration of 200 microg NE, FVart dropped from 71 to 6 cm/sec and was 90% reversible after 48 seconds. Similarly, the renal vascular resistance temporarily rose from 988 to 13711 mm Hg. min/L. In contrast, NE-induced increases in systemic vascular resistance were on average a maximum of 1.5-fold but persisted for more than 60 seconds. CONCLUSIONS: Doppler flow measurements in the renal artery provide an excellent surrogate of volumetric blood flow, which may be useful for continuous monitoring of renal hemodynamics. The renal vasculature is more sensitive when compared with the systemic vasculature, but also appears to evoke more efficient counter-regulatory mechanisms in response to NE.

Animals↗

PubMed2001

Excimer laser-assisted recanalization of long, chronic superficial femoral artery occlusions.

PURPOSE: To examine the safety and efficacy of excimer laser-assisted angioplasty (ELA) for recanalization of superficial femoral artery (SFA) occlusions. METHODS: Data were analyzed from 318 consecutive patients (207 men; mean age 64.2 +/- 10.7 years, range 33-91) who underwent ELA of 411 SFAs with chronic occlusions averaging 19.4 +/- 6.0 cm in length. More than 75% of patients had severe claudication (category 3). Critical lower limb ischemia with rest pain or minor tissue loss was present in 6 and 15 patients, respectively. The mean ankle brachial index (ABI) before and after exercise was 0.62 +/- 0.15 and 0.40 +/- 0.18, respectively. RESULTS: The initial attempt (crossover approach 89.7%, antegrade 6.6%, transpopliteal 3.6%) to cross the occlusion with an excimer laser catheter was successful in 342 (83.2%) of 411 limbs. A secondary attempt performed in 44 of 69 failed cases was successful in 30 limbs, increasing the technical success rate to 90.5% (372/411). Complications included acute reocclusion (4, 1.0%), perforation (9, 2.2%), and distal thrombosis/embolization (16, 3.9%). Postprocedurally, 219 (68.8%) patients were asymptomatic; mild (category 1) or moderate (category 2) claudication remained in 53 (16.6%) and 26 (8.2%) patients, respectively. The primary patency at 1 year was 33.6%. In the majority of patients, reocclusion was treatable on an outpatient basis. The 1-year assisted primary and secondary patency rates were 65.1% and 75.9%, respectively. CONCLUSIONS: Long SFA occlusions can be recanalized safely and successfully by ELA. However, to maintain patency and quality of life, intensive surveillance using objective testing followed by prompt repeat intervention are mandatory.

Adult↗

PubMed2001

Pseudoaneurysm formation at the site of external iliac artery stents: percutaneous stent-graft treatment.

PURPOSE: To present a patient who developed an asymptomatic large iliac pseudoaneurysm complicating stent-supported iliac artery recanalization. CASE REPORT: The pseudoaneurysm was detected in an asymptomatic 69-year-old man during routine angiography 6 months after an uncomplicated procedure to implant 3 overlapping Palmaz stents in an occluded external iliac artery. There was no evidence of stent infection. During a second intervention, the pseudoaneurysm was successfully treated by percutaneous implantation of an EndoPro System I stent-graft. Contrast-enhanced spiral computed tomography at 6 and 12 months confirmed the durability of aneurysm exclusion and the patency of the endoprosthesis. CONCLUSIONS: Angioplasty-induced pseudoaneurysm is rare and usually asymptomatic, but elective percutaneous stent-graft repair should be considered as the first treatment option.

Aged↗

PubMed2000

Treatment of iliac artery aneurysms by percutaneous implantation of stent grafts.

BACKGROUND: Iliac artery aneurysms have traditionally been treated by direct surgical reconstruction. Endovascular stent grafts have been developed to provide an effective but less invasive treatment option for patients with peripheral arterial aneurysms. METHODS AND RESULTS: In 48 patients, a total of 53 endoprostheses (mean length 7. 3 cm, mean diameter 8.1 mm) were implanted into the iliac arteries (common iliac artery n=29, external iliac artery n=19) for percutaneous exclusion of aneurysmal lesions. The technical success of complete exclusion of the aneurysm was achieved in 47 of 48 cases (97.9%). In 1 case, persistent perfusion through a collateral branch was detected; however, this aneurysm thrombosed spontaneously within 2 weeks. In all patients, graft patency was monitored by clinical examination, which included the standardized treadmill test with calculation of the ankle-brachial Doppler index and color-coded duplex ultrasound. Forty-two of the 48 patients (87.5%) underwent follow-up angiography. According to Kaplan-Meier life-table calculations, primary patency rates were 100% after 1 year, 97.9% after 2 years, 94.9% after 3 years, and 87.6% after 4 years. Serial contrast-enhanced spiral CT scans were performed to rule out late procedural failures and to assess growth progression of the lesions. No secondary leaks were observed. Furthermore, the aneurysm diameter had reduced from 24.8+/-8.0 mm to 23.1+/-6.6 mm at the last follow-up (P:=NS). CONCLUSIONS: Stent grafts are a safe and effective treatment option for iliac artery aneurysms and provide good long-term patency of the graft.

Aged↗

PubMed2000

Treatment of catheter-induced iliac artery injuries with self-expanding endografts.

PURPOSE: To evaluate the efficacy of fabric-covered endoprostheses for percutaneous repair of traumatic iliac artery lesions. METHODS: Among 47 patients treated for catheter-induced iliac artery injuries, 20 (42%) patients (13 men; mean age 58 +/- 10 years, range 41-76) presented with acute (n = 7) or subacute (n = 13) lesions considered inappropriate for bare stent implantation (17 dissecting aneurysms, 2 perforations, and 1 traumatic arteriovenous fistula). The self-expanding Cragg EndoPro System I or Passager devices were deployed percutaneously to exclude the defects. RESULTS: Immediate exclusion of the lesion was achieved in all 20 cases; there were no major procedural complications. However, within 24 hours after implantation, fever (n = 11, 55%) and elevations in white blood cell count (n = 10, 50%) and C-reactive protein (n = 13, 65%) were seen in the majority of patients, which prolonged hospitalization in this group (8.4 versus 4.2 days). During a median 21-month follow-up (range 5-31), 2 angiographically documented restenoses at the outlet of the endografts were treated successfully with balloon angioplasty, achieving primary and secondary patency rates of 87% and 100%, respectively. CONCLUSIONS: Early model stent-grafts provided a safe and effective endovascular treatment for iliac perforations and large arterial dissections, showing a high mid-term patency rate. However, postimplantation syndrome appears to occur frequently with this type of Dacron-covered nitinol device.

Adult↗

PubMed2000

[Percutaneous therapy of catheter-induced traumatic vascular lesions with Dacron coated nitinol stents].

OBJECTIVE: Percutaneous peripheral interventional procedures as well as coronary interventions can be complicated by dissections and traumatic lesions of peripheral arteries. The aim of this study was to evaluate the efficacy of fabric covered endoprostheses for percutaneous repair of traumatic peripheral arterial lesions. PATIENTS AND METHODS: In this study we used the EndoPro 1/Passager device (Boston Scientific, USA), which is a self-expanding nitinol stent covered by an ultrathin layer of dacron fabric. In 27 patients a total number of 31 endoprostheses (mean length 7.3 cm) were implanted in iliac (n = 20), femoral (n = 6) and popliteal arteries (n = 1). Indications for stenting were large dissections (n = 24), arterial perforations (n = 2) and one traumatic arterio-venous fistula. RESULTS: An immediate exclusion of the lesion could be achieved in all cases. There were no major procedural complications. However, within 24 hours after implantation 14 patients (51.9%) developed fever. WBC and CRP were elevated in 13 (48.1%) and 17 (63%) patients, respectively. Repeated blood cultures could not show any bacterial growth. The primary patency after a mean follow-up of 19 (5 to 31) months was 85.2%. In two cases with markedly impaired peripheral run-off subacute graft occlusions occurred. In 2 other cases the angiography revealed relevant restenoses (> 75%). The patency could be restored in 2 of these 4 cases leading to a secondary patency rate of 92.6%. CONCLUSIONS: The EndoPro 1/Passager endoprosthesis seems to be safe and effective to seal large dissections and traumatic lesions of peripheral arteries, showing a high long-term patency rate.

Adult↗

PubMed1999

Stent-supported reconstruction of the aortoiliac bifurcation with the kissing balloon technique.

BACKGROUND: Bilateral iliac artery obstructions involving the aortic bifurcation or high-grade stenosis of the abdominal aorta are not usually considered an indication for percutaneous treatment. The purpose of the present study was to evaluate the initial and long-term results of primary stent implantation for reconstruction of the aortic bifurcation. METHODS AND RESULTS: In 48 patients with obstructions of the aortoiliac segment, primary stent implantation was performed with the "kissing balloon technique." Preinterventional angiography showed bilateral stenoses (>85%) of the proximal common iliac arteries in 25 patients, unilateral occlusions and contralateral stenosis in 22 patients, and bilateral occlusion in 1 patient. In 7 cases, stents were placed for the treatment of high-grade infrarenal aortic stenoses. After excimer laser-assisted recanalization of the common iliac artery obstructions, the aortic bifurcation was reconstructed with the bilateral simultaneous implantation of Palmaz stents (diameter, 7 to 8 mm). Stents used for the treatment of aortic stenoses (Palmaz, n=6; Gianturco, n=1) had a diameter ranging from 20 to 25 mm. In all patients, stents were placed successfully (residual stenosis <30%) and without complications. A clinical improvement of +2 to +3 according to American Heart Association criteria was observed in 41 and 7 patients, respectively. Follow-up was performed clinically (standardized treadmill testing and color-coded Doppler ultrasound) and angiographically. The primary angiographic patency rate (24-month follow-up) was 86.8%. In 3 patients, angiography revealed significant restenoses, which were successfully treated with percutaneous transluminal angioplasty. CONCLUSIONS: Primary stent implantation with the kissing balloon technique is safe and effective for the treatment of aortoiliac obstructions involving the aortic bifurcation and represents a true endovascular alternative to surgery.

Angioplasty, Balloon↗