Teaching Case

Bifurcational aortoiliac disease with bilateral iliac stenosis

Patient came to see his doctor for bilateral claudication starting at his upper thighs. Duplex sonography showed pathologic doppler signal in both groins and the patient was admitted for angiography. Angiography in an a.p view showed eccentric plaque of the distal aorta and a stenotic lesion at the orifice of the left common iliac artery (Fig. 1 a). An angulated view, however, revealed extension of the plaque into the distal aorta and another plaque cmpromising the orifice also of the right common iliac artery (Fig. 1b).

It was decided to perform bilateral PTA of the iliac artery which was unsuccessful to gain a sufficient lumen (Fig. 2a). Therefore, two 8 mm balloon-expandable stents (Corinthian, Cordis Inc.) were placed simultaneously into both proximal common iliac arteries (Fig. 2b) that were able to restore patency on both sides (Fig. 1 c). Bifurcational stenting with stents that protrude into the distal aorta is a useful tool to reconstruct bifurcational aortoiliac disease.From our experience, we recommend to use stiff balloon-expandable stents in order to avoid compression of one stent by another placed side-by-side into the aortic bifurcation whicht could happen in case self-expanding stents are used. Furthermore, simultaneous implantation is recommended to achieve an optimal result for both sides.