The Impact of Common-to-External Iliac Arterial Diameter Ratio on Mid- to Long-term Patency of Kissing Aortoiliac Stents

Purpose: To identify anatomical characteristics affecting the primary patency of the kissing stent (KS) technique in patients with aortoiliac occlusive disease (AIOD), with a focus on the external iliac artery (EIA) diameter. Materials and Methods: All consecutive patients treated for AIOD with KSs between January 1, 2015, and December 31, 2021, were retrospectively analyzed. A total of 107 patients exhibiting all classes of Trans-Atlantic Inter-Society Consensus (TASC) lesions were included (28, 36, 24, and 19 TASC Class A, B, C, and D, respectively). Preprocedural anatomical features were evaluated by reviewing computed tomography (CT) angiography images to record the vessel size, plaque calcifications, and aortic thrombi. The primary outcome was primary patency and the secondary outcomes were technical success, secondary patency, and procedure-related reinterventions over time. Results: Technical success was achieved in 99% of cases. The median follow-up was 36 months (interquartile range, 32–42 months; range, 0–84 months); Kaplan-Meier estimates of primary patency rates were 100%, 94%, 91%, and 86% at 3 months and 1, 2, and 4 years, respectively. Advanced age, postdeployment balloon angioplasty molding of the stents, and the increase in maximum aortic diameter were protective factors against primary patency failure. In contrast, the common iliac artery (CIA)/EIA ratio was a significant predictor of primary patency failure, with a 5.3-fold increased risk when the ratio was ≥1.5. Conclusions: Higher CIA/EIA ratio and smaller aortic diameter were relevant predictors of primary patency failure of KS technique. These anatomical features should be evaluated for the treatment choice, particularly in younger patients.