Outcomes of Kissing Stent Technique for the Endovascular Treatment of Aorto-Iliac TASC C/D Lesions

Background: Aorto-iliac Trans-Atlantic Inter-Society Consensus II (TASC II) C and D lesions with involvement of the aortic bifurcation are complex, and their endovascular treatment with kissing stenting can be technically demanding. The aim of this study is to analyze the outcomes, risk factors and follow-up of aorto-iliac revascularization through kissing stenting. Methods: A single-center, retrospective, observational study was performed including patients treated with aorto-iliac kissing stenting from 2016 to 2025 for TASC II C and D lesions. Pre-/peri- and post-operative data were prospectively collected and retrospectively analyzed. Aorto-iliac calcification consisted of calcific lesions involving more than 70% of the aortic circumference. Technical and clinical success, primary patency and reintervention rate were analyzed. Results: Overall, 123 patients were included, 48 (39%) female; mean age was 68 ± 7 years. Sixty-nine patients (56%) had critical limb-threatening ischemia, 46 (37%) diabetes mellitus, 5 (4%) end-stage chronic kidney disease in hemodialysis and 68 (55%) aortic calcification. Femoral accesses were percutaneous in 18 (15%) and surgical in 105 (85%) cases; additional brachial access was used in 49 (40%) patients. Simultaneous femoral endarterectomy was performed in 48 (39%) cases. Stentgrafts and bare metal stents were used in 32 (26%) and 91 (74%) cases, respectively. Technical success was 100%. Primary patency at 1, 3 and 5 years was 100%, 98 ± 3% and 94 ± 5%, respectively. At a mean follow up of 39 months, 6 (5%) stent thromboses occurred. Freedom from reintervention at 1, 3 and 5 years was 99%, 93% and 81%, respectively. Calcification was associated with a higher 3-year reintervention rate: 13% vs. 0%, p = 0.037. Brachial access, additional femoral endarterectomy and use of covered stents did not affect the reintervention rate. Conclusions: Kissing stent is an effective and safe technique to provide revascularization in aorto-iliac TASC C-D lesions with involvement of the aortic bifurcation, with good outcomes in terms of technical, clinical success and primary patency. It often needs an upper limb access and/or adjunctive procedures such as femoral endarterectomy. Presence of severe calcification is associated with a higher reintervention rate.