<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1646-706X</journal-id>
<journal-title><![CDATA[Angiologia e Cirurgia Vascular]]></journal-title>
<abbrev-journal-title><![CDATA[Angiol Cir Vasc]]></abbrev-journal-title>
<issn>1646-706X</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Angiologia e Cirurgia Vascular]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1646-706X2021000400334</article-id>
<article-id pub-id-type="doi">10.48750/acv.345</article-id>
<title-group>
<article-title xml:lang="pt"><![CDATA[Técnica de double kissing (DK) crush para o tratamento de doença arterial periférica complexa]]></article-title>
<article-title xml:lang="en"><![CDATA[Double kissing (DK) crush technique for the treatment of complex peripheral disease]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Lopes]]></surname>
<given-names><![CDATA[Alice]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Amorim]]></surname>
<given-names><![CDATA[Pedro]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Vieira]]></surname>
<given-names><![CDATA[João]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Albino]]></surname>
<given-names><![CDATA[Pereira]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Lusíadas Lisboa  ]]></institution>
<addr-line><![CDATA[Lisboa ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>30</day>
<month>12</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>12</month>
<year>2021</year>
</pub-date>
<volume>17</volume>
<numero>4</numero>
<fpage>334</fpage>
<lpage>338</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S1646-706X2021000400334&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S1646-706X2021000400334&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S1646-706X2021000400334&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução:  O tratamento de lesões arteriais complexas com oclusões longas e envolvimento da bifurcação das artérias tibiais permanece um desafio técnico na área endovascular que muitas vezes culmina com a escolha de uma alternativa cirúrgica convencional. Dadas as semelhanças de calibre arterial e de material necessário, a adaptação de técnicas utilizadas nas lesões de bifurcações na circulação coronária para o território infra-popliteo tem permitido mudar o paradigma de tratamento.  Material e métodos:  Neste trabalho é apresentado um caso clínico de um doente com doença arterial periférica complexa tratada com a técnica de double kissing (DK) crush.  Caso clínico:  Doente de 74 anos, do sexo masculino, hipertenso e fumador, já previamente submetido a exclusão endovascular de aneurisma da aorta abdominal infra-renal e a safenectomia bilateral da veia grande safena, com diagnóstico de isquémia crónica ameaçadora de membro à esquerda - Rutherford 4. A AngioTC revelou uma oclusão femoro-poplitea longa (30cm) com reabitação ao nível do tronco tibioperoneal (TTP). Apesar da extensão e localização da lesão, os antecedentes cirúrgicos do doente, a ausência de veia grande safena eas múltiplas abordagens cirúrgicas femorais prévias fizeram com que o doente fosse inicialmente proposto para tratamento endovascular utilizando a técnica de DK crush. Através de um acesso percutâneo da femoral superficial ipsilateral a lesão foi recanalizada e foi colocado um fio-guia nas artérias peroneal e tibial posterior. A bifurcação do TTP foi pré-dilatada em kissing (1º kissing balloon) e foi colocado um stent expansível por balão (Xience Sierra® 3×18mm) na tibial posterior (TP). Posteriormente foi colocado um segundo stent expansível por balão (Xience Sierra® 3.5×18mm) na artéria peroneal com consequente crush da porção proximal do 1º stent. O fio-guia da TP foi removido e reintroduzido através das malhas dos stents e depois realizado o segundo kissing balloon da bifurcação com excelente resultado angiográfico. Por último, foi realizada a angioplastia femoro-poplitea com colocação de stents auto-expansíveis (Zilver PTX®) em gradação crescente. Aos 9 meses de follow-up o doente apresenta-se sem queixas e com permeabilidade mantida de todo o eixo arterial, nomeadamente as artérias peroneal e TP, evidente em ecodoppler de controlo.  Conclusão:  No caso apresentado, a adaptação da técnica de DK crush ao território tibio-peroneal permitiu a revascularização eficaz de uma lesão arterial complexa, com bom resultado a médio-prazo.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction:  The treatment of complex arterial lesions with long occlusions and involvement of the bifurcation of the tibial arteries remains a technical challenge in the endovascular area that often culminates in the choice of a conventional surgical alternative. Given the similarities in arterial caliber and necessary material, the adaptation of techniques used in lesions of bifurcations in the coronary circulation to the infrapopliteal territory has allowed a change in the treatment paradigm.  Material and methods:  This article presents a clinical case of a patient with complex peripheral arterial disease treated with the double kissing (DK) crush technique.  Clinical case:  74-year-old male patient, hypertensive, and smoker, previously submitted to endovascular exclusion of infra-renal abdominal aortic aneurysm and bilateral saphenectomy, diagnosed with chronic limb-threatening ischemia of the left limb - Rutherford 4. AngioCT revealed a long (30 cm) femoropopliteal occlusion with rehabilitation at the level of the tibioperoneal trunk (TPT). Despite the extent and location of the lesion, the patient's surgical history, the absence of a great saphenous vein, and multiple previous femoral surgical approaches led the patient to be initially proposed for endovascular treatment using the DK crush technique. The lesion was recanalized through percutaneous access of the ipsilateral superficial femoral artery, and a guidewire was placed in the peroneal and posterior tibial arteries. The TPT bifurcation was predilated in kissing (1st kissing balloon), and a balloon-expandable stent (Xience Sierra® 3×18mm) was placed in the posterior tibialis (PT). Subsequently, a second balloon-expandable stent (Xience Sierra® 3.5×18mm) was placed in the peroneal artery with the consequent crush of the proximal portion of the 1st stent. The PT guidewire was removed and reintroduced through the stent mesh, and then the second kissing balloon of the bifurcation was performed, with an excellent angiographic result. Finally, femoropopliteal angioplasty was performed with placement of self-expanding stents (Zilver PTX®) in increasing degrees. The patient had no complaints and maintained patency of the entire arterial axis at nine months of follow-up, namely the peroneal and PT arteries, evident on the control ultrasound.  Conclusion:  In the case presented here, the adaptation of the DK crush technique to the tibial-peroneal territory allowed the effective revascularization of a complex arterial lesion, with good results in the medium term.]]></p></abstract>
<kwd-group>
<kwd lng="pt"><![CDATA[Isquémia crítica]]></kwd>
<kwd lng="pt"><![CDATA[Angioplastia]]></kwd>
<kwd lng="pt"><![CDATA[Stenting]]></kwd>
<kwd lng="pt"><![CDATA[Infra-popliteo]]></kwd>
<kwd lng="pt"><![CDATA[Bifurcações]]></kwd>
<kwd lng="en"><![CDATA[Critical ischemia]]></kwd>
<kwd lng="en"><![CDATA[Angioplasty]]></kwd>
<kwd lng="en"><![CDATA[Stenting]]></kwd>
<kwd lng="en"><![CDATA[Infra-popliteal]]></kwd>
<kwd lng="en"><![CDATA[bifurcations]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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<article-title xml:lang=""><![CDATA[Clinical outcome after DK crush versus culotte stenting of distal left main bifurcation lesions the 3-year follow-up results of the DKCRUSH-III study]]></article-title>
<source><![CDATA[J Am Coll Cardiol Intv]]></source>
<year>2015</year>
<volume>8</volume>
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