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 kiss-ing 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 bifurca-tion) 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 pro-trusion mismatch, intended as the longitudinal distance between the stents' proximal ends. "Conformability"was measured as radial mismatch (area and volume of the "dead space"be-tween 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 mm(2), and the mean radial mismatch volume was 2442 +/- 182 mm(3). 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.