This case report describes a complex endovascular aorto-iliac recanalization and reconstruction in a TASC II D lesion. Many open questions are still present in this field, such as the role of open surgery, the necessity to use covered stents, and the neverending story between self- and balloon-expandable stents.


    MD Michel Bosiers
    September 3, 2018

    Great case, Thanks for sharing!
    I have a few questions:
    – would you consider a transbrachial approach instead of cross-over: sometimes you don´t have enough pushability coming from cross-over.
    – was it necessary to stent the left EIA ?

    To answer your questions:
    – i prefer to use balloon expandable stents for the CIA, for the EIA i totally agree to use a self expandable.
    – if there is a large thrombus burden, i prefer to use covered stents, in this case with the strong calcification i think a non-covered stent should do the trick

    MD, MHM Nicola Troisi
    September 4, 2018

    Thank you Michel for your comments.
    Step by step…
    As regards as the right side the first approach was retrograde femoral but I was not able to recanalize the iliac axis. So, I decided to perform a crossover approach. In my mind, the third option should be the brachial approach with a long sheath.
    Then, the choice to stent left EIA was based on the preoperative CT-scan showing circumferential calcifications with critical stenosis in the distal part immediately above the circumflex arteries.
    Finally, about your answers I am agree with you even if in my center we have a large experience of iliac kissing stenting with self-expandable stents with good outcomes during a long-term follow-up. I use covered stents just in cases where large thrombus is present.

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