A novel application of the culotte stent technique to bail out a jailed common iliac artery Hideto Sangen, MD, Shuhei Tara, MD, PhD, Takahisa Tanaka,

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A novel application of the culotte stent technique to bail out a jailed common iliac artery Hideto Sangen, MD, Shuhei Tara, MD, PhD, Takahisa Tanaka, MD, Hitoshi Takano, MD, PhD, Kunio Tanaka, MD, PhD, Wataru Shimizu, MD, PhD Journal of Vascular Surgery Cases and Innovative Techniques Volume 3, Issue 4, Pages 236-239 (December 2017) DOI: 10.1016/j.jvscit.2017.09.005 Copyright © 2017 The Author(s) Terms and Conditions

Fig 1 The first endovascular therapy (EVT) resulted in successful revascularization of the left common iliac artery (CIA) with a self-expandable stent (SES; blue dotted lines). However, a protruded SES from the left CIA accidentally jailed the right CIA (yellow circle; A). One year after the first EVT, a progressed stenosis at the ostium of the right CIA, which was completely jailed by the previously implanted SES, was confirmed (B). Journal of Vascular Surgery Cases and Innovative Techniques 2017 3, 236-239DOI: (10.1016/j.jvscit.2017.09.005) Copyright © 2017 The Author(s) Terms and Conditions

Fig 2 Representative angiograms of the second endovascular therapy (EVT; A and C) and a schematic of the protective sheath technique (B). Arterial dissection occurred after balloon dilation at the ostial stenosis of the right common iliac artery (CIA; A). Culotte stenting was applied to bail out the ostial stenosis. A protective sheath technique was used to introduce a balloon-expandable stent (BES) between the stent struts of the self-expandable stent (SES; B). Final angiography and intravascular ultrasound demonstrated successful culotte stenting with adequate stent dilation (C). Journal of Vascular Surgery Cases and Innovative Techniques 2017 3, 236-239DOI: (10.1016/j.jvscit.2017.09.005) Copyright © 2017 The Author(s) Terms and Conditions

Fig 3 A, Schematic images of the kissing stent, T-stent, and culotte stent techniques. Both kissing stent and culotte stent techniques can keep two routes open from the femoral arteries to the aorta and heart after the procedures. B, Extracorporeal validation to evaluate a change of stent structures in culotte stenting. An Express LD stent (10 × 37 mm) was placed between struts of the SMART stent (10 × 40 mm). A >7-mm balloon could be used to break the strut of the SMART stent and could dilate the Express LD stent sufficiently (circles). KBT, Kissing balloon technique. Journal of Vascular Surgery Cases and Innovative Techniques 2017 3, 236-239DOI: (10.1016/j.jvscit.2017.09.005) Copyright © 2017 The Author(s) Terms and Conditions