Geometrical Analysis and Preliminary Results for the Endovascular Reconstruction of Aortic Bifurcation Using New-Generation Balloon-Expandable Covered Stents in the Kissing Conformation

Background: The purpose of the study is to perform a postimplantation geometrical analysis and to evaluate early and mid-term outcomes of new-generation balloon-expandable covered stents, used in the kissing conformation to treat obstructive lesions involving the aortic bifurcation. Methods: A single-center retrospective review of all patients who underwent endovascular reconstruction of the aortoiliac bifurcation for obstructive disease, with the use of Viabahn balloon expandable stents (VBX; W. L. Gore & Associates, Flagstaff, AZ) deployed in the kissing conformation, from March 2018 to June 2019 was carried out. Two same-size kissing VBXs were simultaneously deployed from the distal aorta (1.5–2 cm above the aortic bifurcation) to the common iliac arteries; a kissing post-ballooning using compliant balloons was routinely performed to flare the proximal part of the VBX, to adapt to the aortic diameter and morphology. A postoperative computed tomography (CT) angiogram was obtained for all patients for the geometrical assessment. “Precision” of deployment was measured as protrusion mismatch, intended as the longitudinal distance between the stents’ proximal ends. “Conformability” was measured as radial mismatch (area and volume of the “dead space” between the stented lumen and the aortic wall) and D-ratio (ratio of the major and minor axes in the axial view). Symmetry was measured as the ratio between the minor diameter of the 2 kissing stents at the same level. Results: Twenty-eight patients (56 limbs) underwent endovascular treatment with kissing VBXs for Trans-Atlantic Inter-Society Consensus II C (n = 10, 36%) or D (n = 18, 64%) lesions involving the aortic bifurcation. Two 8-mm diameter (“8L”) VBX stents were used in most cases (n = 32, 57%). At the postoperative CT, the mean protrusion mismatch was 0.8 ± 1.7 mm and was <5 mm in all cases. The mean radial mismatch area was 20.4 ± 10.6 mm2, and the mean radial mismatch volume was 2442 ± 182 mm3. The mean D-ratio was 1.4 ± 0.2. Early procedural and postprocedural complication rates were 4% and 0%, respectively. After 9.7 ± 4.2 months of follow-up, no cases of limb occlusion or restenosis occurred. Conclusions: The use of kissing VBX stents may represent a valid option for the treatment of obstructive lesions involving the aortic bifurcation, with excellent early and mid-term outcomes and achievement of optimal stents geometry.