Presentation
TASC II D AORTO-ILIAC RECANALIZATION AND RECONSTRUCTION WITH SELF-EXPANDABLE STENTS
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.
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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
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.