Systematic review of results of kissing stents in the treatment of aortoiliac occlusive disease

Introduction: Severe stenosis or occlusion of the aortoiliac bifurcation is typically treated with open surgery. Patency results of aorto-bifemoral bypass are up to 90 % at 5 years. However, the number and severity of complications seem to have reached a plateau level. A less invasive technique, the kissing stent (KS) is available nowadays. The goal of this review was to give an overview of the current results and status of the kissing stent technique. Method: The Scopus search engine was used to retrieve articles concerning KS, this retrieved 78 abstracts, 60 were rejected and 4 more were rejected after full text screening. One article was included after cross referencing. After a quality check, data was extracted for further analysis. Results: 810 patients ( 72.8 % Rutherford classification of 1/2/3) were included. The most prevalent risk factor was hypertension (37.5-96%) and 50% of patients were treated for TASC C & D lesions. Overall the technical success rate was 98.2 %. Procedural protocols greatly differed on applying protrusion and pre or post dilatation. Clinical improvement at 30 days was achieved in 89.9%. Primary patency at 12, 24, and 36 months was 88.8%, 78.9 and 68.5, respectively. A complication rate of 11 % was reported, of which most are minor . No detailed analysis could be performed because individual patient data are lacking. Conclusion: KS treatment of aortoiliac disease is related with only minor complications and acceptable midterm patency results, this can however not surpass the results seen with open surgery.