Aorto-iliac kissing stent angioplasty is a specialized minimally invasive procedure used to treat blockages or severe narrowing in the aorto-iliac arteries, which supply blood to the lower limbs. The technique involves placing two stents—one in each iliac artery—so that they “kiss” or touch at their origin in the lower aorta. This restores blood flow, relieves leg pain, improves walking ability, and reduces the risk of limb loss. It has become a preferred alternative to open surgical bypass for many patients because of its lower risks, quicker recovery, and durable outcomes.
The aorta is the body’s main artery, carrying oxygen-rich blood from the heart. As it travels downward into the abdomen, it divides into the common iliac arteries, which then branch further to supply blood to the pelvis and legs. Narrowing or blockage of these vessels—known as aorto-iliac occlusive disease—impairs circulation to the lower limbs. Traditionally managed with open aorto-bifemoral bypass surgery, many of these cases are now treated with advanced endovascular techniques such as kissing stent angioplasty.
The primary cause of aorto-iliac disease requiring kissing stents is atherosclerosis—the build-up of fatty deposits inside arterial walls. Other contributing factors include:
Smoking – a major risk factor for vascular disease.
Diabetes mellitus – accelerates plaque build-up and worsens circulation.
High cholesterol and triglycerides – promote fatty deposits in arteries.
Hypertension – damages arterial walls over time.
Chronic kidney disease – linked with vascular calcification.
Genetic predisposition and age – older individuals and those with family history are more at risk.
Patients with aorto-iliac disease often present with:
Intermittent claudication – cramping or pain in the buttocks, thighs, or calves when walking.
Rest pain – persistent pain in the feet or toes, especially at night.
Non-healing ulcers or sores on the feet and legs.
Cold, pale, or discolored limbs due to poor circulation.
Erectile dysfunction in men (Leriche’s syndrome when combined with claudication).
Weak or absent pulses in the groin or legs on examination.
Aorto-iliac disease is diagnosed through a combination of clinical assessment and imaging:
Clinical examination – checking for absent pulses, skin changes, and wound healing issues.
Ankle-Brachial Index (ABI) – compares blood pressure in the ankle with that in the arm; a low ABI suggests significant arterial narrowing.
Duplex ultrasound – provides information on blood flow and location of narrowing.
CT Angiography (CTA) or MR Angiography (MRA) – gives a detailed map of the aorto-iliac arteries and blockages.
Digital Subtraction Angiography (DSA) – often performed immediately before the procedure to guide stent placement.
Treatment depends on the severity of disease and patient health:
Lifestyle modification – smoking cessation, diet changes, and regular exercise.
Medications – antiplatelets (aspirin, clopidogrel), cholesterol-lowering drugs (statins), and medications for blood pressure and diabetes control.
Wound care and foot protection – important in cases of ulcers or tissue loss.
Endovascular angioplasty and stenting – the first-line treatment for many patients, including kissing stent technique for bifurcation lesions.
Aorto-bifemoral bypass surgery – open surgery, usually reserved for younger or high-risk patients with long, complex blockages not suitable for stenting.
Extra-anatomic bypass (axillo-femoral bypass) – considered when standard surgery is not feasible.
The kissing stent technique is typically performed in a catheterization lab by a vascular specialist:
Preparation – patient is given local anesthesia with sedation; groin arteries are cleaned and numbed.
Access – catheters are inserted through punctures in the femoral arteries.
Angiography – contrast dye and X-rays are used to visualize blockages.
Crossing the blockage – guidewires are threaded through the narrowed or blocked arteries.
Balloon angioplasty – small balloons are inflated to widen the arteries.
Stent placement – two stents are positioned, one in each iliac artery, extending slightly into the aorta where they touch (“kiss”).
Final dilation – both stents are expanded simultaneously with balloons to ensure a proper seal and alignment.
Completion angiography – final imaging confirms good blood flow.
Closure – catheters are removed and puncture sites sealed.
The entire procedure usually takes 1–2 hours, and most patients are discharged within 24–48 hours.
Recovery after kissing stent angioplasty is typically quick:
Monitoring – short hospital stay to watch for bleeding or complications.
Medications – dual antiplatelet therapy (aspirin and clopidogrel) is prescribed to prevent stent blockage.
Lifestyle modification – smoking cessation, healthy diet, and exercise remain crucial.
Wound and skin care – if ulcers or tissue damage were present.
Follow-up imaging – regular duplex ultrasound or CT scans to ensure stents remain open.
Supervised exercise therapy – improves walking distance and circulation.
Though considered safe, kissing stent angioplasty carries potential risks:
Bleeding or hematoma at the puncture site.
Allergic reaction or kidney injury from contrast dye.
Arterial dissection or rupture during the procedure.
Blood clot formation within the stent.
Restenosis – narrowing inside the stent over time.
Infection (rare).
The kissing stent technique provides excellent results for aorto-iliac occlusive disease. Patients often experience significant symptom relief, improved walking distance, and healing of ulcers. Long-term outcomes are generally favorable, with stent patency (keeping open) rates of 80–90% at 3–5 years when combined with risk factor control. Ongoing lifestyle modification and medical therapy are essential for maintaining long-term success.
Patients should seek medical attention if they experience:
Persistent leg pain during activity or at rest.
Non-healing wounds or ulcers on the feet or legs.
Cold, pale, or discolored limbs.
Sudden worsening of circulation (acute limb ischemia).
Aorto-iliac kissing stent angioplasty is a modern, minimally invasive procedure that restores blood flow in patients with severe aorto-iliac disease. By reducing pain, improving mobility, and preventing limb loss, it has transformed outcomes for many patients who previously faced high-risk open surgery. Early recognition of symptoms and timely consultation with a vascular specialist are vital to achieving the best results.
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