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Figure 9 Iliac Stenting for Claudication

A 68-year-old man presented with severe lifestyle-limiting claudication despite maximum medical therapy including aspirin, cilostazol, atorvastatin, an exercise program, and an aggressive control of all modifiable risk factors including smoking cessation. A noninvasive work-up, including ankle-brachial indices (<0.60 bilaterally) and a magnetic resonance angiogram, suggested severe bilateral aortoiliac and external iliac disease. (A) Abdominal angiography demonstrates bilateral long-segment high-grade disease in the left and right common and external iliac arteries. (B) Kissing balloon angioplasty after placement of 2 self-expanding 9.0 x 100 mm Absolute (Guidant, Temecula, California) stents in the left and right common iliac arteries in the "hugging stent" manner. An additional 8.0 x 56 mm Absolute stent is also placed in an overlapping manner in the left external iliac artery. (C) Final abdominal angiogram reveals no significant residual stenosis and resolution of all resting gradients followed by dramatic symptomatic improvement.