Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient

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The presentation of AIOD ranges from asymptomatic cases to limb-threatening emergencies. Advances and innovations in endovascular devices have replaced traditional surgical interventions for the management of AIOD. Here we report a case of a 52-year-old man presenting with AIOD managed by endovascular approach using kissing stent technique. Case presentation A 52-year-old man, with history of chronic coronary artery disease, diabetes mellitus type 2, long-standing hypertension, and a significant history of smoking, was admitted to our hospital with symptoms of long-standing bilateral claudication which recently progressed to rest pain. A history of AIOD was previously established. AIOD (TASC II Type D) diagnosis was made by lower extremity duplex ultrasound and CT angiography. The patient underwent urgent percutaneous transluminal angioplasty with kissing stent technique. The patient was discharged 4 days after the procedure without any significant complaints, received best medical therapy. Conclusion Endovascular interventions present excellent alternatives to surgical techniques in the treatment of complex AIOD. Herein we presented an endovascular treatment of AIOD utilizing the kissing stent technique which showed satisfactory outcomes. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/12-477", "name": "Case Report: Endovascular approach with kissing stent technique in..." } } ] } Home Browse Case Report: Endovascular approach with kissing stent technique in... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Dakota I, Taofan T, Indriani S et al. Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient [version 3; peer review: 2 approved] . F1000Research 2024, 12 :477 ( https://doi.org/10.12688/f1000research.133373.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Revised Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient [version 3; peer review: 2 approved] Iwan Dakota https://orcid.org/0000-0001-5360-2759 1 , Taofan Taofan https://orcid.org/0000-0001-6363-9010 1 , Suci Indriani https://orcid.org/0000-0002-9156-0390 1 , [...] Jonathan Edbert Afandy https://orcid.org/0000-0002-4691-8226 2 , Yislam Al Jaidi 3 , Suko Adiarto https://orcid.org/0000-0002-2848-0566 1 , Renan Sukmawan 1 Iwan Dakota https://orcid.org/0000-0001-5360-2759 1 , Taofan Taofan https://orcid.org/0000-0001-6363-9010 1 , [...] Suci Indriani https://orcid.org/0000-0002-9156-0390 1 , Jonathan Edbert Afandy https://orcid.org/0000-0002-4691-8226 2 , Yislam Al Jaidi 3 , Suko Adiarto https://orcid.org/0000-0002-2848-0566 1 , Renan Sukmawan 1 PUBLISHED 06 Nov 2024 Author details Author details 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia / National Cardiovascular Center Harapan Kita / University of Indonesia Academic Hospital, Jakarta, Indonesia 2 Assistant of Vascular Division, Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia / National Cardiovascular Center Harapan Kita / University of Indonesia Academic Hospital, Jakarta, Indonesia 3 Cardiology Resident, Departement of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia / National Cardiovascular Center Harapan Kita / University of Indonesia Academic Hospital, Jakarta, Indonesia Iwan Dakota Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Taofan Taofan Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Suci Indriani Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Jonathan Edbert Afandy Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Yislam Al Jaidi Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Suko Adiarto Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Renan Sukmawan Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Aortoiliac occlusive disease (AIOD) or Leriche syndrome, is a form of peripheral arterial disease involving the infrarenal aorta and iliac arteries. The presentation of AIOD ranges from asymptomatic cases to limb-threatening emergencies. Advances and innovations in endovascular devices have replaced traditional surgical interventions for the management of AIOD. Here we report a case of a 52-year-old man presenting with AIOD managed by endovascular approach using kissing stent technique. Case presentation A 52-year-old man, with history of chronic coronary artery disease, diabetes mellitus type 2, long-standing hypertension, and a significant history of smoking, was admitted to our hospital with symptoms of long-standing bilateral claudication which recently progressed to rest pain. A history of AIOD was previously established. AIOD (TASC II Type D) diagnosis was made by lower extremity duplex ultrasound and CT angiography. The patient underwent urgent percutaneous transluminal angioplasty with kissing stent technique. The patient was discharged 4 days after the procedure without any significant complaints, received best medical therapy. Conclusion Endovascular interventions present excellent alternatives to surgical techniques in the treatment of complex AIOD. Herein we presented an endovascular treatment of AIOD utilizing the kissing stent technique which showed satisfactory outcomes. READ ALL READ LESS Keywords aortoiliac occlusive disease, Leriche syndrome, TASC D, endovascular therapy, percutaneous transluminal angioplasty, kissing stent Corresponding Author(s) Taofan Taofan ( [email protected] ) Close Corresponding author: Taofan Taofan Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Dakota I et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Dakota I, Taofan T, Indriani S et al. Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient [version 3; peer review: 2 approved] . F1000Research 2024, 12 :477 ( https://doi.org/10.12688/f1000research.133373.3 ) First published: 09 May 2023, 12 :477 ( https://doi.org/10.12688/f1000research.133373.1 ) Latest published: 06 Nov 2024, 12 :477 ( https://doi.org/10.12688/f1000research.133373.3 ) Revised Amendments from Version 2 The manuscript has been revised according to reviewer comments. Few highlights including: - Grammatical correction. - Misused term correction. - Additional references in the discussion. - Removing paragraph discussing the non-technical aspect of the case. The manuscript has been revised according to reviewer comments. Few highlights including: - Grammatical correction. - Misused term correction. - Additional references in the discussion. - Removing paragraph discussing the non-technical aspect of the case. See the authors' detailed response to the review by Yopie Afriandi Habibie See the authors' detailed response to the review by Vangelis Bontinis READ REVIEWER RESPONSES Introduction Aortoiliac occlusive disease (AIOD), also known as Leriche syndrome results from a chronic occlusive process of the infrarenal aorta and iliac arteries and is one of the cause of peripheral arterial disease (PAD). Epidemiological studies about PAD including AIOD and infrainguinal artery disease have reported that most patients presented with multistage disease. PAD is rare under the age of 50 years, increasing to about 20% by age 60 years and over 40% by age 85 years. An ankle brachial index (ABI) lower than 0.9 is used to diagnose PAD in clinical practice and epidemiologic studies, to identify both symptomatic and asymptomatic patients. 1 , 2 Risk factors for AIOD include hypertension, hyperglycemia, hyperlipidemia, nicotine use, age, male gender, and family history. AIOD patients generally present with a classic triad of clinical symptoms: (1) claudication of lower extremities, (2) impotence, and (3) weak/absence of femoral pulse. Diagnosis of AIOD is made with CT angiography or conventional angiography. Angiography was used to determine the location of the obstruction, length, collateral circulation, and distal patency. 1 , 3 Advances and innovations in endovascular devices offered promising alternatives over standard surgical approach, including in long and complex lesions. Endovascular treatment in the aortoiliac segment has shown high technical success and lower complication rates compared to standard surgery. It also provides excellent patency, making it a valuable option to be considered for Trans-Atlantic Inter-Society Consensus (TASC) C and D lesions, especially in patients who are poor candidates for surgery. 4 Here we report a 52-year-old man presenting with AIOD or Leriche syndrome and managed by an endovascular approach using a kissing stent technique in the National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. Case report A 52-year-old Javanese man was referred to our hospital with a history of chronic coronary artery disease, type 2 diabetes mellitus, long-standing hypertension, and who was a heavy smoker. Over the past year, the patient experienced long-standing bilateral claudication which recently progressed to rest pain, accompanied by occasional episodes of chest pain, particularly during prolonged walking. Additionally, the patient reported symptoms of erectile dysfunction. The patient had known AOID diagnosed following a failed percutaneous coronary intervention (PCI) attempt. His previous medication was aspilet 80 mg once daily, clopidogrel 75 mg once daily, rivaroxaban 15 mg once daily, bisoprolol 2.5 mg once daily, isosorbide mononitrate 2.5 mg twice a day, candesartan 16 mg once daily, simvastatin 20 mg once daily and novorapid 3×16 IU sub cutaneously before meals. Physical examination showed blood pressure 160/86 mmHg, HR 68 bpm, RR 18 breaths per minute, temperature 36°C. Normal cardiac, abdominal, and extremity examinations. ECG showed sinus rhythm. Chest radiograph revealed cardiomegaly (65% of cardio thoracic ratio (CTR)) and aorta elongation. Laboratory examination was within normal limits. Lower extremity duplex ultrasound (DUS) suspected significant stenosis of the abdominal aorta at the infra-renal level with high end-diastolic monophasic doppler curve in both external iliac artery and common femoral artery and rounded doppler curve in both popliteal, anterior, and posterior tibial artery, no thrombus in the deep veins in both limbs, and positive arterial flow to distal to both legs. Pletismography examination revealed right ABI was 0.42 and left was 0.35, right toe brachial index (TBI) was 0.45 and left 0.49. Lower extremity CT scan angiography (CTA) showed infrarenal abdominal aortic occlusion from aortic bifurcation, to bilateral common iliac artery and causes suspected thrombus, intermittent atherosclerosis of the abdominal aorta, arterial vasculature of both extremities filled distally, no stenosis or occlusion was seen ( Figure 1 ). Figure 1. Pre-procedural CT scan angiography. The patient was diagnosed with chronic limb threatening ischaemia (TASC II type D lesion) causing bilateral aortic infrarenal–iliaca occlusion (Leriche syndrome). The patient was planned to undergo urgent percutaneous transluminal angioplasty (PTA). He got Enoxaparin 60 mg sub cutaneously twice per day, some additional anti-hypertension therapy, and other previous drugs were continued. The procedure was done by puncturing access via the right brachial artery with a 6F Radial sheath (Terumo, Japan). A JR 3.5/5F diagnostic catheter (Radifocus™ Optitorque™, Terumo, Japan) with support of 0.035 mm exchange wire (Terumo, Japan) was placed in the abdominal aorta above the suprarenal. The aorta blood pressure measurement was 191/74 (120) mmHg. Initial aortography was done and revealed total occlusion in the abdominal aorta from infrarenal the aortoiliac bifurcation until bilateral common iliac arteries ( Figure 2B ). Access puncture was then done via both femoral arteries with a 6F Femoral sheath (Terumo, Japan). Blood pressure measurement was done in the femoral artery, the right femoral artery blood pressure was 87/64 (75) mmHg, and the left femoral artery blood pressure was 89/66 (76) mmHg. A 0.035 mm exchange wire (Terumo, Japan) with support of Rubicon 35 Microcatheter (Boston Scientific, MA, US) was used to penetrate the lesion from the right femoral artery and continued from the left femoral artery. Several pre-dilations with 5.0×120×135 mm balloon (Mustang ® , Boston Scientific, MA, US) were performed for 10 seconds with a pressure of 4 atm on the right and left iliac arteries ( Figure 2C and D ). Then, aortography was performed again and showed positive flow on both right and left femoral arteries ( Figure 2E ). Insertion of 12×95×100 mm stent graft (Seal ® , S&G Biotech, Korea) from the right femoral artery access and 12×75×80 mm stent graft (Seal ® , S&G Biotech, Korea) from the left femoral artery access were done ( Figure 2F ). Dilatation of the stents was performed with a kissing stent technique using a 5.0×120×135 mm balloon (Mustang ® , Boston Scientific, MA, US) from the right femoral artery access and a 6.0×100×135 mm balloon (Mustang ® , Boston Scientific, MA, US) from the left femoral artery access simultaneously with pressure of 8 − 12 atm for 10 seconds ( Figure 2G ). Following the intervention abdominal aorta blood pressure was 170 / 79 (114) mmHg, right femoral artery blood pressure was 141/68 (98) mmHg, and left femoral artery blood pressure was 137/77 (102) mmHg ( Figure 2H ). The total contrast used was 260 mL iopromide 769 mg/mL, dose area product 418.62 Gy.cm 2 , and fluoro time was 24.53 minutes. Figure 2. Percutaneus transluminal angioplasty procedure. After the procedure, the patient was observed in the intermediate ward. Lower extremity DUS didn’t find any pseudoaneurysm/AV fistula in the right-left femoral region nor deep vein thrombus in both legs, arterial flow was positive to distal of both legs. Plethysmography results were right ABI 0.8 and left 0.77, right TBI 0.75 and left 0.74. Lower extremity CTA revealed patent stent at bilateral common iliac artery, contrast flow was presence to bilateral femoral artery, bilateral infrapopliteal artreies, until bilateral malleolus region especially left anterior tibial artery and right posterior tibial artery. Other contrast flow was improved compared to pre-PTA ( Figure 3 ). The patient was discharged 4 days after the procedure without any significant complaints, continued his previous medication, and was educated about smoking cessation. Figure 3. Post-procedural CT scan angiography. Discussion Definitive treatment approaches to AIOD have changed in recent years. Inter-Society Consensus for the Management of Peripheral Arterial Disease suggested that AIOD patients with TASC C and D classification are preferred for surgical treatment, but there has been a shift in the recent guidelines by the European Society of Cardiology and of the European Society for Vascular Surgery suggested that endovascular-first strategy may be considered for AIOD for patient with severe comorbidities and if done by an experienced team. 5 , 6 Endovascular therapy is a less invasive treatment option and may reduce morbidity. Patients with extensive AIOD could be treated using endovascular techniques with 86% to 100% of the patients' technical success rates. 7 Another recent study by Dong et al . 8 evaluated uninterrupted patency of the treated lesion until 5 years follow-up of AIOD patient treated with endovascular approach was as high as 91.3% and 100% restored blood flow through the original target lesion. Several available reported endovascular techniques for AIOD treatments including covered endovascular reconstruction of the aortic bifurcation (CERAB), unibody bifurcated endografts, and kissing stent technique showed promising patency outcomes. 9 – 11 Although several studies have analyzed factors that may affect long-term patency after endovascular treatment of AIOD, including stent placement, lesion morphology, and outflow, there is no consensus currently on the risk factors associated with restenosis after endovascular intervention in patients with AIOD. 12 A randomized trial comparing primary versus selective stenting for AIOD showed similar long-term patency in both groups, with lower costs in the selective stenting group. 13 Nevertheless, most studies for extensive aortoiliac lesions preferred primary stenting. The argument for primary stenting was that stenting without predilatation (direct stenting) reduced the risk of not only vessel rupture but also distal embolism. 12 A study by AbuRahma et al . 14 showed that selective stenting was associated with reduced clinical success in long lesions and that primary stenting should be the option for all TASC II type C and D lesions. In our case, we preferred to do the primary stenting for a better long term clinical succes and patency since our patient was presented with extensive aortoiliac lesions (TASC II type D lesion). Tegtmeyer was the first to describe bilateral simultaneous balloon angioplasty, known as kissing balloon technique, as a potential endovascular treatment for bilateral proximal common iliac artery stenoses or focal aortic bifurcation. 15 However frequent complications occurred, such as dissections and poor angiographic and/or hemodynamic outcomes. Later, the repair of the aortic bifurcation using concurrently placed bilateral stents, known as kissing stents technique, was documented. This made the majority of aortoiliac atherosclerotic lesions amenable to percutaneous therapy. 16 Systematic review by Jebbink et al . 11 revealed that the use of kissing stent technique in AIOD had a 98.7% success rate, 10.8% complication rate, 89.9% clinical improvement achieved in 30 days, and 89.3%, 78.6%, and 69.0% primary patency rate at 12, 24, and 60 months respectively. According to the stent type, Sabri et al . 17 mentioned that for atherosclerotic aortic bifurcation occlusive disease, covered balloon-expandable kissing stents have greater patency at 2 years compared to bare metal balloon-expandable stents. Recent individual participant data meta-analysis by Bontinis, et al. 18 also reported improved 48 months patency of covered stent compared with bare metal stent in the treatment of TASC C and D lesions with 92.4% (95% CI 84.7 – 100%) and 80.8% (95% CI 64.5 – 100%) patency rate respectively. We used kissing stent technique with covered balloon-expandable stent and showed a very good result. Despite improved blood flow in short-term follow-up by CT scan and duplex ultrasound, long-term follow-up needs to be done for the patient. Conclusion We presented a case of a patient with AIOD (Leriche syndrome) TASC II type D which successfully underwent endovascular treatment utilizing covered kissing stent technique with a good result and blood flow improvement to distal area of lower extremity. Endovascular approach in TASC II type C and D lesions is an excellent alternative to the traditional surgical technique. Research ethics and patient consent Written informed consent has been obtained from the patient for publication of the case report and accompanying images. Data availability All data underlying the results are available as part of the article and no additional source data are required. Acknowledgements We would like to thank the patients for allowing us to have their cases published. References 1. Kashou AH, Braiteh N, Zgheib A, et al. : Acute aortoiliac occlusive disease during percutaneous transluminal angioplasty in the setting of ST-elevation myocardial infarction: a case report. J. Med. Case Rep. 2018; 12 (1): 6. PubMed Abstract | Publisher Full Text | Free Full Text 2. Buckley B, Holden A, Merrilees S, et al. : 13 - Revascularization: Aortoiliac.Mauro MA, Murphy KP, Thomson KR, et al. , editors. Image-Guided Interventions. Boston: Elsevier; (Third Edition). 2020 (cited 2023 Feb 20); pp. 99–110.e2. (Expert Radiology). Publisher Full Text Reference Source 3. Rodríguez SP, Sandoval F: Aortoiliac occlusive disease, a silent syndrome. BMJ Case Rep. CP. 2019; 12 (7): e230770. PubMed Abstract | Publisher Full Text | Free Full Text 4. Taha AA, Hefnawy ET, Tawfik AR, et al. : Endovascular management of Trans-Atlantic Inter-Society Consensus C and D aortoiliac occlusive disease as a feasible, effective, and durable intervention. Egypt J. Surg. 2017; 36 (4): 401. Publisher Full Text 5. Norgren L, Hiatt WR, Dormandy JA, et al. : Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J. Vasc. Surg. 2007; 45 (1): S5–S67. Publisher Full Text 6. Aboyans V, Ricco JB, Bartelink MLEL, et al. : 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur. Heart J. 2018; 39 (9): 763–816. PubMed Abstract | Publisher Full Text 7. Jongkind V, Akkersdijk GJM, Yeung KK, et al. : A systematic review of endovascular treatment of extensive aortoiliac occlusive disease. J. Vasc. Surg. 2010; 52 (5): 1376–1383. PubMed Abstract | Publisher Full Text 8. Dong X, Peng Z, Ren Y, et al. : Endovascular treatment of aorto-iliac occlusive disease with TASC II C and D lesions: 10 year’s experience of clinical technique. BMC Cardiovasc. Disord. 2023; 23 (1): 71. PubMed Abstract | Publisher Full Text | Free Full Text 9. Bontinis V, Bontinis A, Giannopoulos A, et al. : Covered endovascular reconstruction of the aortic bifurcation: A systematic review aggregated data and individual participant data meta-analysis. J. Vasc. Surg. 2024 Jun 1; 79 (6): 1525–1535.e9. PubMed Abstract | Publisher Full Text 10. Manaki V, Bontinis V, Bontinis A, et al. : Bifurcated Endografts for the Treatment of Aortoiliac Disease a Systematic Review and Individual Patient Data (IPD) Meta-Analysis. J. Endovasc. Ther. 2024 Oct 7: 15266028241283721. PubMed Abstract | Publisher Full Text 11. Jebbink EG, Holewijn S, Slump CH, et al. : Systematic Review of Results of Kissing Stents in the Treatment of Aortoiliac Occlusive Disease. Ann. Vasc. Surg. 2017; 42 : 328–336. PubMed Abstract | Publisher Full Text 12. Yang M, Zhang B, Niu G, et al. : Long-term results of endovascular reconstruction for aortoiliac occlusive disease. Quant. Imaging Med. Surg. 2021; 11 (4): 1303–1312. PubMed Abstract | Publisher Full Text | Free Full Text 13. Klein WM, van der Graaf Y , Seegers J, et al. : Dutch Iliac Stent Trial: Long-term Results in Patients Randomized for Primary or Selective Stent Placement. Radiology. 2006; 238 (2): 734–744. Publisher Full Text 14. AbuRahma AF, Hayes JD, Flaherty SK, et al. : Primary iliac stenting versus transluminal angioplasty with selective stenting. J. Vasc. Surg. 2007; 46 (5): 965–970.e2. PubMed Abstract | Publisher Full Text 15. Tegtmeyer CJ, Kellum CD, Kron IL, et al. : Percutaneous transluminal angioplasty in the region of the aortic bifurcation. The two-balloon technique with results and long-term follow-up study. Radiology. 1985; 157 (3): 661–665. Publisher Full Text 16. Sharafuddin MJ, Hoballah JJ, Kresowik TF, et al. : Kissing Stent Reconstruction of the Aortoiliac Bifurcation. Perspect. Vasc. Surg. Endovasc. Ther. 2008 Mar 1; 20 (1): 50–60. Publisher Full Text 17. Sabri SS, Choudhri A, Orgera G, et al. : Outcomes of Covered Kissing Stent Placement Compared with Bare Metal Stent Placement in the Treatment of Atherosclerotic Occlusive Disease at the Aortic Bifurcation. J. Vasc. Interv. Radiol. 2010; 21 (7): 995–1003. PubMed Abstract | Publisher Full Text 18. Bontinis V, Bontinis A, Giannopoulos A, et al. : Editor’s Choice – Covered Stents Versus Bare Metal Stents in the Treatment of Aorto-iliac Disease: A Systematic Review and Individual Participant Data Meta-analysis. Eur. J. Vasc. Endovasc. Surg. 2024 Sep 1; 68 (3): 348–358. PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 09 May 2023 ADD YOUR COMMENT Comment Author details Author details 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia / National Cardiovascular Center Harapan Kita / University of Indonesia Academic Hospital, Jakarta, Indonesia 2 Assistant of Vascular Division, Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia / National Cardiovascular Center Harapan Kita / University of Indonesia Academic Hospital, Jakarta, Indonesia 3 Cardiology Resident, Departement of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia / National Cardiovascular Center Harapan Kita / University of Indonesia Academic Hospital, Jakarta, Indonesia Iwan Dakota Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Taofan Taofan Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Suci Indriani Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Jonathan Edbert Afandy Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Yislam Al Jaidi Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Suko Adiarto Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Renan Sukmawan Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (3) version 3 Revised Published: 06 Nov 2024, 12:477 https://doi.org/10.12688/f1000research.133373.3 version 2 Revised Published: 04 Jul 2024, 12:477 https://doi.org/10.12688/f1000research.133373.2 version 1 Published: 09 May 2023, 12:477 https://doi.org/10.12688/f1000research.133373.1 Copyright © 2024 Dakota I et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Dakota I, Taofan T, Indriani S et al. Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient [version 3; peer review: 2 approved] . F1000Research 2024, 12 :477 ( https://doi.org/10.12688/f1000research.133373.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 3 VERSION 3 PUBLISHED 06 Nov 2024 Revised Views 0 Cite How to cite this report: Bontinis V. Reviewer Report For: Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient [version 3; peer review: 2 approved] . F1000Research 2024, 12 :477 ( https://doi.org/10.5256/f1000research.174143.r338351 ) The direct URL for this report is: https://f1000research.com/articles/12-477/v3#referee-response-338351 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 09 Nov 2024 Vangelis Bontinis , Aristotle University of Thessaloniki, Thessaloniki, Greece Approved VIEWS 0 https://doi.org/10.5256/f1000research.174143.r338351 The authors have adequately addressed my concerns, and I believe ... Continue reading READ ALL The authors have adequately addressed my concerns, and I believe the article is now thoroughly updated and suitable for indexing. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Vascular Surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Bontinis V. Reviewer Report For: Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient [version 3; peer review: 2 approved] . F1000Research 2024, 12 :477 ( https://doi.org/10.5256/f1000research.174143.r338351 ) The direct URL for this report is: https://f1000research.com/articles/12-477/v3#referee-response-338351 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 2 VERSION 2 PUBLISHED 04 Jul 2024 Revised Views 0 Cite How to cite this report: Bontinis V. Reviewer Report For: Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient [version 3; peer review: 2 approved] . F1000Research 2024, 12 :477 ( https://doi.org/10.5256/f1000research.168180.r333171 ) The direct URL for this report is: https://f1000research.com/articles/12-477/v2#referee-response-333171 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 25 Oct 2024 Vangelis Bontinis , Aristotle University of Thessaloniki, Thessaloniki, Greece Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.168180.r333171 General comments - I commend the authors for presenting an intriguing case. However, the manuscript requires careful grammatical revision, as multiple errors are evident throughout the text. Abstract “is a peripheral artery disease, ... Continue reading READ ALL General comments - I commend the authors for presenting an intriguing case. However, the manuscript requires careful grammatical revision, as multiple errors are evident throughout the text. Abstract “is a peripheral artery disease, specifically affecting the infrarenal aorta and iliac arteries.” Comment: Rephrase since this English can be improved. A suggestion would be “ .. is a form of peripheral arterial disease involving the….” “Presentation of AIOD patients ranged from asymptomatic to having limb-threatening emergencies “ Rephrase Comment: “ The presentation of AIOD ranges from asymptomatic cases to limb-threatening emergencies” “Advances and innovations in endovascular devices have replaced surgical approach for AIOD treatment. Here we reported a 52-year-old man presenting with AIOD managed by endovascular approach using kissing stent technique.” Comment: …”have replaced traditional surgical interventions for the management of AIOD. Here we report a case of a….” “and who was a heavy smoker” Comment: “and a significant history of smoking” “long time with bilateral claudication” Comment : “long-standing bilateral claudication which recently progressed to rest pain” “He had history of aorto-infrarenal occlusion known from previous percutaneous coronary intervention from right and left femoral artery access.” Comment: “A history of aortoiliac occlusive disease (TASC II Type D) was previously established” optimal medical treatment Comment “best medical therapy (BMT)” “Treatment of AIOD should include both modification of risk factors and efforts to increase perfusion to the lower extremities. An endovascular approach is an excellent alternative and may replace surgical approach in complex aortoiliac obstructive disease. In this case report, an endovascular approach with kissing stent technique showed good results for the patient.” Comment: You can’t just pop up a comment about risk modification parameters out of nowhere. Then you just performed a case of a kissing stent you can’t claim that just because of this one case endovascular techniques will surpass surgical interventions. These conclusions are merely grounded on your limited persona experience A suggested rephrase is “Endovascular interventions present excellent alternatives to surgical techniques in the treatment of complex aortoiliac obstructive disease. Herein we presented, an endovascular treatment of AIOD utilizing the kissing stent technique which showcased satisfactory outcomes.” Introduction “is the leading cause of peripheral arterial disease (PAD)” Comment: About 1/3 of PAD cases present with aortoiliac involvement and very few of them are complete occlusions! The most common distribution of PAD lesions involve femoropopliteal lesions! “ nicotine use, age, sex, and family history” Comment: you mean “male gender” “ Advances and innovations in endovascular devices have replaced standard surgical approach with endovascular approach, including in long and complex lesions. An endovascular approach is currently recommended as the definitive interventional treatment for AIOD” Comment: First avoid repeating the same words within a sentence. Then, no they have not replaced surgical techniques and they are not recommended over surgery. As a matter of fact, this is much more complicated than you suggest with TASC guidelines suggesting endovascular surgery for TASC A and B lesions and surgery for TASC C D lesions (which include occlusions). Additionally, more recent guidelines advocate for endovascular treatment in short lesions or occlusions. So please correct this Case report “Javanese man” Comment: I believe the authors mean "Japanese" “ bilateral leg pain in the” Comment: You mean claudication or rest pain? “He had symptoms of worsening bilateral leg pain in the past year, and felt chest pain sometimes, especially when he was walking for long distances. Another clinical symptom that he had was impotence. “ Comment: This English can be improved and a suggested rephrase would be “Over the past year, the patient experienced progressive bilateral leg pain, accompanied by occasional episodes of chest pain, particularly during prolonged walking. Additionally, the patient reported symptoms of erectile dysfunction.” “ The patient had a history of aorto-infrarenal occlusion that was known when he underwent percutaneous coronary intervention (PCI) via the right radial artery but failed after the approach was moved to both sides of femoral artery access because of the occlusion in bilateral common iliac arteries one year earlier. “ Comment: This paragraph fails to provide any clarity unfortunately. In my opinion the fact that he had an attempt to PCI and they it failed is of no true value to the manuscript. You can just state that the patient had known AOID diagnosed following a failed PCI attempt. “ Insertion of 12×95×100 mm bifurcated stent graft extension (Seal ® , S&G Biotech, Korea) from the right femoral artery access and 12×75×80 mm bifurcated stent graft extension (Seal ® , S&G Biotech, Korea) from the left femoral artery access were done ( Figure 2F )” Comment: What I see here are covered stents and not bifurcated grafts which in reality you could not have used so please correct this as this is a major error! “ The final result of the procedure was positive flow until the distal part of both common femoral” Comment: There is no such thing as a positive or negative flow. Omit this while sentence and just state “Following the intervention abdominal aorta blood pressure was 170 / 79 (114) mmHg, right femoral artery blood pressure was 141/68 (98) mmHg, and left femoral artery blood pressure was 137/77 (102) mmHg” “ Lower extremity CTA revealed patent kissing stent graft” Comment: Kissing stents are not grafts they are just kissing stents positive flow to bilateral femoral artery, bilateral subpopliteal artery, until bilateral malleolus region especially left anterior tibial artery and right posterior tibial artery Comment: Again there is not such a thing as positive flow. There is either presence of flow (monophasic biphasic signal on doppler) or presence or absence of pulses. Please state which one was in your case. There is not an artery called subpopliteal, there are however infrapopliteal artreies (anterio, posterior tibial and peroneal) Discussion Comment: Endovascular techniques is a general term in your first paragraph you should report on the available endovascular techniques including CERAB and unibody endografts. Also update you reference list accordingly - 1. (Bontinis V et al. [2024 (Ref - 1)]) DOI: 10.1016/j.jvs.2023.12.021, 2. (Manaki V et al. [2024 (Ref - 2)]) DOI: 10.1177/15266028241283721 Sabri et al.15 mentioned that for atherosclerotic aortic bifurcation occlusive disease, covered balloon-expandable kissing stents have greater patency at 2 years compared to bare metal balloon-expandable stents. We used kissing stent technique with covered balloon-expandable stent and showed a very good result. Despite improved blood flow in short-term follow-up by CT scan and duplex ultrasound, long-term follow-up needs to be done for the patient. Comment: Update your references list with the latest IPD meta-analysis describing Covered VS Bare for aotoiliac disea with follow-up intervals up to 10 years (Bontinis V et al. [2024 (Ref - 3)]) 10.1016/j.ejvs.2024.06.008 “ In our case, the patient was a heavy smoker, but he admitted that he just committed to stop smoking. Unfortunately, he had long-standing hypertension and type 2 DM which also were another important risk factor of atherosclerosis process itself. Good teamwork between care provider, patient, and patient’s family should be targeted in this scenario.” Comment: You are presenting a technical manuscript and this is irrelevant in my opinion Conclusion “We had presented a case of a patient with AIOD (Leriche syndrome) TASC II type D which successfully underwent endovascular approach (kissing stent technique) with a good result and blood flow improvement to distal area of lower extremity. Comment : “We presented”, “covered kissing stent technique”, Endovascular management of TASC II type C and D lesions approach is an excellent alternative to the surgical approach The word approach is redundant Comment : the word approach is out of place here Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Partly References 1. Bontinis V, Bontinis A, Giannopoulos A, Manaki V, et al.: Covered endovascular reconstruction of the aortic bifurcation: A systematic review aggregated data and individual participant data meta-analysis. J Vasc Surg . 2024; 79 (6): 1525-1535.e9 PubMed Abstract | Publisher Full Text 2. Manaki V, Bontinis V, Bontinis A, Giannopoulos A, et al.: Bifurcated Endografts for the Treatment of Aortoiliac Disease a Systematic Review and Individual Patient Data (IPD) Meta-Analysis. J Endovasc Ther . 2024. 15266028241283721 PubMed Abstract | Publisher Full Text 3. Bontinis V, Bontinis A, Giannopoulos A, Manaki V, et al.: Editor's Choice - Covered Stents Versus Bare Metal Stents in the Treatment of Aorto-iliac Disease: A Systematic Review and Individual Participant Data Meta-analysis. Eur J Vasc Endovasc Surg . 2024; 68 (3): 348-358 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Vascular Surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Bontinis V. Reviewer Report For: Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient [version 3; peer review: 2 approved] . F1000Research 2024, 12 :477 ( https://doi.org/10.5256/f1000research.168180.r333171 ) The direct URL for this report is: https://f1000research.com/articles/12-477/v2#referee-response-333171 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 06 Nov 2024 Taofan Taofan , Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia / National Cardiovascular Center Harapan Kita / University of Indonesia Academic Hospital, Jakarta, Indonesia 06 Nov 2024 Author Response We would like to thank Dr. Vangelis Bontinis for the constructive insight regarding our manuscript. Here we try to adress and revise our manuscript from Dr. Vangelis Bontinis comments point ... Continue reading We would like to thank Dr. Vangelis Bontinis for the constructive insight regarding our manuscript. Here we try to adress and revise our manuscript from Dr. Vangelis Bontinis comments point by point. Abstract 1. “is a peripheral artery disease, specifically affecting the infrarenal aorta and iliac arteries.” Comment: Rephrase since this English can be improved. A suggestion would be “ .. is a form of peripheral arterial disease involving the….” The sentence has been paraphrased to “Aortoiliac occlusive disease (AIOD) or Leriche syndrome, is a form of peripheral arterial disease involving the infrarenal aorta and iliac arteries.” 2. “Presentation of AIOD patients ranged from asymptomatic to having limb-threatening emergencies “ Rephrase. Comment: “ The presentation of AIOD ranges from asymptomatic cases to limb-threatening emergencies” The sentence has been paraphrased to “The presentation of AIOD ranges from asymptomatic cases to limb-threatening emergencies. 3. “Advances and innovations in endovascular devices have replaced surgical approach for AIOD treatment. Here we reported a 52-year-old man presenting with AIOD managed by endovascular approach using kissing stent technique.” Comment: …”have replaced traditional surgical interventions for the management of AIOD. Here we report a case of a….” The sentences have been paraphrased to “Advances and innovations in endovascular devices have replaced traditional surgical interventions for the management of AIOD. Here we report a case of a 52-year-old man presenting with AIOD managed by endovascular approach using kissing stent technique.” 4. “and who was a heavy smoker” Comment: “and a significant history of smoking”. “long time with bilateral claudication” Comment : “long-standing bilateral claudication which recently progressed to rest pain” The sentence has been paraphrased to “A 52-year-old man, with history of chronic coronary artery disease, diabetes mellitus type 2, long-standing hypertension, and a significant history of smoking, was admitted to our hospital with symptoms of long-standing bilateral claudication which recently progressed to rest pain.” 5. “He had history of aorto-infrarenal occlusion known from previous percutaneous coronary intervention from right and left femoral artery access.” Comment: “A history of aortoiliac occlusive disease (TASC II Type D) was previously established” The sentences have been paraphrased to “A history of AIOD was previously established. AIOD (TASC II Type D) diagnosis was made by lower extremity duplex ultrasound and CT angiography.” 6. optimal medical treatment, Comment “best medical therapy (BMT)” The sentence has been paraphrased to “The patient was discharged 4 days after the procedure without any significant complaints, received best medical therapy.” 7. “Treatment of AIOD should include both modification of risk factors and efforts to increase perfusion to the lower extremities. An endovascular approach is an excellent alternative and may replace surgical approach in complex aortoiliac obstructive disease. In this case report, an endovascular approach with kissing stent technique showed good results for the patient.” Comment: You can’t just pop up a comment about risk modification parameters out of nowhere. Then you just performed a case of a kissing stent you can’t claim that just because of this one case endovascular techniques will surpass surgical interventions. These conclusions are merely grounded on your limited persona experience A suggested rephrase is “Endovascular interventions present excellent alternatives to surgical techniques in the treatment of complex aortoiliac obstructive disease. Herein we presented, an endovascular treatment of AIOD utilizing the kissing stent technique which showcased satisfactory outcomes.” The sentences have been paraphrased to Endovascular interventions present excellent alternatives to surgical techniques in the treatment of complex AIOD. Herein we presented an endovascular treatment of AIOD utilizing the kissing stent technique which showcased satisfactory outcomes. Introduction 8. “is the leading cause of peripheral arterial disease (PAD)” Comment: About 1/3 of PAD cases present with aortoiliac involvement and very few of them are complete occlusions! The most common distribution of PAD lesions involve femoropopliteal lesions! The sentence has been paraphrased to “Aortoiliac occlusive disease (AIOD), also known as Leriche syndrome results from a chronic occlusive process of the infrarenal aorta and iliac arteries and is one of the cause of peripheral arterial disease (PAD).” 9. “ nicotine use, age, sex, and family history” Comment: you mean “male gender” The sentence has been paraphrased to “Risk factors for AIOD include hypertension, hyperglycemia, hyperlipidemia, nicotine use, age, male gender, and family history.” 10. “ Advances and innovations in endovascular devices have replaced standard surgical approach with endovascular approach, including in long and complex lesions. An endovascular approach is currently recommended as the definitive interventional treatment for AIOD” Comment: First avoid repeating the same words within a sentence. Then, no they have not replaced surgical techniques and they are not recommended over surgery. As a matter of fact, this is much more complicated than you suggest with TASC guidelines suggesting endovascular surgery for TASC A and B lesions and surgery for TASC C D lesions (which include occlusions). Additionally, more recent guidelines advocate for endovascular treatment in short lesions or occlusions. So please correct this The sentences have been paraphrased to “Advances and innovations in endovascular devices offered promising alternatives over standard surgical approach, including in long and complex lesions. Endovascular treatment in the aortoiliac segment has shown high technical success and lower complication rates compared to standard surgery. It also provides excellent patency, making it a valuable option to be considered for Trans-Atlantic Inter-Society Consensus (TASC) C and D lesions, especially in patients who are poor candidates for surgery.” Case report 11. “Javanese man” Comment: I believe the authors mean "Japanese" Javanese is an ethnic group from Indonesia. It is who we identify as. 12. “ bilateral leg pain in the” Comment: You mean claudication or rest pain? “He had symptoms of worsening bilateral leg pain in the past year, and felt chest pain sometimes, especially when he was walking for long distances. Another clinical symptom that he had was impotence. “ Comment: This English can be improved and a suggested rephrase would be “Over the past year, the patient experienced progressive bilateral leg pain, accompanied by occasional episodes of chest pain, particularly during prolonged walking. Additionally, the patient reported symptoms of erectile dysfunction.” The sentences have been paraphrased to “Over the past year, the patient experienced long-standing bilateral claudication which recently progressed to rest pain, accompanied by occasional episodes of chest pain, particularly during prolonged walking. Additionally, the patient reported symptoms of erectile dysfunction.” 13. “ The patient had a history of aorto-infrarenal occlusion that was known when he underwent percutaneous coronary intervention (PCI) via the right radial artery but failed after the approach was moved to both sides of femoral artery access because of the occlusion in bilateral common iliac arteries one year earlier. “ Comment: This paragraph fails to provide any clarity unfortunately. In my opinion the fact that he had an attempt to PCI and they it failed is of no true value to the manuscript. You can just state that the patient had known AOID diagnosed following a failed PCI attempt. The sentence has been paraphrased to “The patient had known AOID diagnosed following a failed percutaneous coronary intervention (PCI) attempt.” 14. “ Insertion of 12×95×100 mm bifurcated stent graft extension (Seal®, S&G Biotech, Korea) from the right femoral artery access and 12×75×80 mm bifurcated stent graft extension (Seal®, S&G Biotech, Korea) from the left femoral artery access were done (Figure 2F)” Comment: What I see here are covered stents and not bifurcated grafts which in reality you could not have used so please correct this as this is a major error! It has been corrected to “Insertion of 12×95×100 mm stent graft (Seal ®, S&G Biotech, Korea) from the right femoral artery access and 12×75×80 mm stent graft (Seal ®, S&G Biotech, Korea) from the left femoral artery access were done.” 15, “ The final result of the procedure was positive flow until the distal part of both common femoral” Comment: There is no such thing as a positive or negative flow. Omit this while sentence and just state “Following the intervention abdominal aorta blood pressure was 170 / 79 (114) mmHg, right femoral artery blood pressure was 141/68 (98) mmHg, and left femoral artery blood pressure was 137/77 (102) mmHg” The sentence has been paraphrased to “Following the intervention abdominal aorta blood pressure was 170 / 79 (114) mmHg, right femoral artery blood pressure was 141/68 (98) mmHg, and left femoral artery blood pressure was 137/77 (102) mmHg.” 16. “ Lower extremity CTA revealed patent kissing stent graft”. Comment: Kissing stents are not grafts they are just kissing stents. Positive flow to bilateral femoral artery, bilateral subpopliteal artery, until bilateral malleolus region especially left anterior tibial artery and right posterior tibial artery Comment: Again there is not such a thing as positive flow. There is either presence of flow (monophasic biphasic signal on doppler) or presence or absence of pulses. Please state which one was in your case. There is not an artery called subpopliteal, there are however infrapopliteal artreies (anterio, posterior tibial and peroneal) The sentences have been paraphrased to “Lower extremity CTA revealed patent kissing stent graft at bilateral common iliac artery, positive contrast flow was presence to bilateral femoral artery, bilateral infrapopliteal artreies subpopliteal artery, until bilateral malleolus region especially left anterior tibial artery and right posterior tibial artery.” Discussion 17. Comment: Endovascular techniques is a general term in your first paragraph you should report on the available endovascular techniques including CERAB and unibody endografts. Also update you reference list accordingly - 1. (Bontinis V et al. [2024 (Ref - 1)]) DOI: 10.1016/j.jvs.2023.12.021, 2. (Manaki V et al. [2024 (Ref - 2)]) DOI: 10.1177/15266028241283721 Available endovascular techniques have been mentioned in the paragraph: “Several available reported endovascular techniques for AIOD treatments including covered endovascular reconstruction of the aortic bifurcation (CERAB), unibody bifurcated endografts, and kissing stent technique showed promising patency outcomes.” 18. Sabri et al.15 mentioned that for atherosclerotic aortic bifurcation occlusive disease, covered balloon-expandable kissing stents have greater patency at 2 years compared to bare metal balloon-expandable stents. We used kissing stent technique with covered balloon-expandable stent and showed a very good result. Despite improved blood flow in short-term follow-up by CT scan and duplex ultrasound, long-term follow-up needs to be done for the patient. Comment: Update your references list with the latest IPD meta-analysis describing Covered VS Bare for aotoiliac disea with follow-up intervals up to 10 years (Bontinis V et al. [2024 (Ref - 3)]) 10.1016/j.ejvs.2024.06.008 Reference has been updated mentioning IPD meta-analysis by Bontinis V, et al. “Recent individual participant data meta-analysis by Bontinis, et al. also reported improved 48 months patency of covered stent compared with bare metal stent in the treatment of TASC C and D lesions with 92.4% (95% CI 84.7 – 100%) and 80.8% (95% CI 64.5 – 100%) patency rate respectively.” 19. “ In our case, the patient was a heavy smoker, but he admitted that he just committed to stop smoking. Unfortunately, he had long-standing hypertension and type 2 DM which also were another important risk factor of atherosclerosis process itself. Good teamwork between care provider, patient, and patient’s family should be targeted in this scenario.” Comment: You are presenting a technical manuscript and this is irrelevant in my opinion The paragraph has been removed from the manuscript Conclusion 20. “We had presented a case of a patient with AIOD (Leriche syndrome) TASC II type D which successfully underwent endovascular approach (kissing stent technique) with a good result and blood flow improvement to distal area of lower extremity. Comment : “We presented”, “covered kissing stent technique”, Endovascular management of TASC II type C and D lesions approach is an excellent alternative to the surgical approach The word approach is redundant Comment : the word approach is out of place here The sentences have been paraphrased to “We presented a case of a patient with AIOD (Leriche syndrome) TASC II type D which successfully underwent endovascular treatment utilizing( covered kissing stent technique) with a good result and blood flow improvement to distal area of lower extremity. Endovascular approach of in TASC II type C and D lesions is an excellent alternative to the traditional surgical technique.” Once again, I really appreciate the time and effort that you have invested in reviewing my manuscript. Your insights were helpful, and I am truly grateful for your support and expertise. Please let us know if further revision is needed. Thank you for your contribution to our manuscript. Best regards, Taofan, MD Departement of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia We would like to thank Dr. Vangelis Bontinis for the constructive insight regarding our manuscript. Here we try to adress and revise our manuscript from Dr. Vangelis Bontinis comments point by point. Abstract 1. “is a peripheral artery disease, specifically affecting the infrarenal aorta and iliac arteries.” Comment: Rephrase since this English can be improved. A suggestion would be “ .. is a form of peripheral arterial disease involving the….” The sentence has been paraphrased to “Aortoiliac occlusive disease (AIOD) or Leriche syndrome, is a form of peripheral arterial disease involving the infrarenal aorta and iliac arteries.” 2. “Presentation of AIOD patients ranged from asymptomatic to having limb-threatening emergencies “ Rephrase. Comment: “ The presentation of AIOD ranges from asymptomatic cases to limb-threatening emergencies” The sentence has been paraphrased to “The presentation of AIOD ranges from asymptomatic cases to limb-threatening emergencies. 3. “Advances and innovations in endovascular devices have replaced surgical approach for AIOD treatment. Here we reported a 52-year-old man presenting with AIOD managed by endovascular approach using kissing stent technique.” Comment: …”have replaced traditional surgical interventions for the management of AIOD. Here we report a case of a….” The sentences have been paraphrased to “Advances and innovations in endovascular devices have replaced traditional surgical interventions for the management of AIOD. Here we report a case of a 52-year-old man presenting with AIOD managed by endovascular approach using kissing stent technique.” 4. “and who was a heavy smoker” Comment: “and a significant history of smoking”. “long time with bilateral claudication” Comment : “long-standing bilateral claudication which recently progressed to rest pain” The sentence has been paraphrased to “A 52-year-old man, with history of chronic coronary artery disease, diabetes mellitus type 2, long-standing hypertension, and a significant history of smoking, was admitted to our hospital with symptoms of long-standing bilateral claudication which recently progressed to rest pain.” 5. “He had history of aorto-infrarenal occlusion known from previous percutaneous coronary intervention from right and left femoral artery access.” Comment: “A history of aortoiliac occlusive disease (TASC II Type D) was previously established” The sentences have been paraphrased to “A history of AIOD was previously established. AIOD (TASC II Type D) diagnosis was made by lower extremity duplex ultrasound and CT angiography.” 6. optimal medical treatment, Comment “best medical therapy (BMT)” The sentence has been paraphrased to “The patient was discharged 4 days after the procedure without any significant complaints, received best medical therapy.” 7. “Treatment of AIOD should include both modification of risk factors and efforts to increase perfusion to the lower extremities. An endovascular approach is an excellent alternative and may replace surgical approach in complex aortoiliac obstructive disease. In this case report, an endovascular approach with kissing stent technique showed good results for the patient.” Comment: You can’t just pop up a comment about risk modification parameters out of nowhere. Then you just performed a case of a kissing stent you can’t claim that just because of this one case endovascular techniques will surpass surgical interventions. These conclusions are merely grounded on your limited persona experience A suggested rephrase is “Endovascular interventions present excellent alternatives to surgical techniques in the treatment of complex aortoiliac obstructive disease. Herein we presented, an endovascular treatment of AIOD utilizing the kissing stent technique which showcased satisfactory outcomes.” The sentences have been paraphrased to Endovascular interventions present excellent alternatives to surgical techniques in the treatment of complex AIOD. Herein we presented an endovascular treatment of AIOD utilizing the kissing stent technique which showcased satisfactory outcomes. Introduction 8. “is the leading cause of peripheral arterial disease (PAD)” Comment: About 1/3 of PAD cases present with aortoiliac involvement and very few of them are complete occlusions! The most common distribution of PAD lesions involve femoropopliteal lesions! The sentence has been paraphrased to “Aortoiliac occlusive disease (AIOD), also known as Leriche syndrome results from a chronic occlusive process of the infrarenal aorta and iliac arteries and is one of the cause of peripheral arterial disease (PAD).” 9. “ nicotine use, age, sex, and family history” Comment: you mean “male gender” The sentence has been paraphrased to “Risk factors for AIOD include hypertension, hyperglycemia, hyperlipidemia, nicotine use, age, male gender, and family history.” 10. “ Advances and innovations in endovascular devices have replaced standard surgical approach with endovascular approach, including in long and complex lesions. An endovascular approach is currently recommended as the definitive interventional treatment for AIOD” Comment: First avoid repeating the same words within a sentence. Then, no they have not replaced surgical techniques and they are not recommended over surgery. As a matter of fact, this is much more complicated than you suggest with TASC guidelines suggesting endovascular surgery for TASC A and B lesions and surgery for TASC C D lesions (which include occlusions). Additionally, more recent guidelines advocate for endovascular treatment in short lesions or occlusions. So please correct this The sentences have been paraphrased to “Advances and innovations in endovascular devices offered promising alternatives over standard surgical approach, including in long and complex lesions. Endovascular treatment in the aortoiliac segment has shown high technical success and lower complication rates compared to standard surgery. It also provides excellent patency, making it a valuable option to be considered for Trans-Atlantic Inter-Society Consensus (TASC) C and D lesions, especially in patients who are poor candidates for surgery.” Case report 11. “Javanese man” Comment: I believe the authors mean "Japanese" Javanese is an ethnic group from Indonesia. It is who we identify as. 12. “ bilateral leg pain in the” Comment: You mean claudication or rest pain? “He had symptoms of worsening bilateral leg pain in the past year, and felt chest pain sometimes, especially when he was walking for long distances. Another clinical symptom that he had was impotence. “ Comment: This English can be improved and a suggested rephrase would be “Over the past year, the patient experienced progressive bilateral leg pain, accompanied by occasional episodes of chest pain, particularly during prolonged walking. Additionally, the patient reported symptoms of erectile dysfunction.” The sentences have been paraphrased to “Over the past year, the patient experienced long-standing bilateral claudication which recently progressed to rest pain, accompanied by occasional episodes of chest pain, particularly during prolonged walking. Additionally, the patient reported symptoms of erectile dysfunction.” 13. “ The patient had a history of aorto-infrarenal occlusion that was known when he underwent percutaneous coronary intervention (PCI) via the right radial artery but failed after the approach was moved to both sides of femoral artery access because of the occlusion in bilateral common iliac arteries one year earlier. “ Comment: This paragraph fails to provide any clarity unfortunately. In my opinion the fact that he had an attempt to PCI and they it failed is of no true value to the manuscript. You can just state that the patient had known AOID diagnosed following a failed PCI attempt. The sentence has been paraphrased to “The patient had known AOID diagnosed following a failed percutaneous coronary intervention (PCI) attempt.” 14. “ Insertion of 12×95×100 mm bifurcated stent graft extension (Seal®, S&G Biotech, Korea) from the right femoral artery access and 12×75×80 mm bifurcated stent graft extension (Seal®, S&G Biotech, Korea) from the left femoral artery access were done (Figure 2F)” Comment: What I see here are covered stents and not bifurcated grafts which in reality you could not have used so please correct this as this is a major error! It has been corrected to “Insertion of 12×95×100 mm stent graft (Seal ®, S&G Biotech, Korea) from the right femoral artery access and 12×75×80 mm stent graft (Seal ®, S&G Biotech, Korea) from the left femoral artery access were done.” 15, “ The final result of the procedure was positive flow until the distal part of both common femoral” Comment: There is no such thing as a positive or negative flow. Omit this while sentence and just state “Following the intervention abdominal aorta blood pressure was 170 / 79 (114) mmHg, right femoral artery blood pressure was 141/68 (98) mmHg, and left femoral artery blood pressure was 137/77 (102) mmHg” The sentence has been paraphrased to “Following the intervention abdominal aorta blood pressure was 170 / 79 (114) mmHg, right femoral artery blood pressure was 141/68 (98) mmHg, and left femoral artery blood pressure was 137/77 (102) mmHg.” 16. “ Lower extremity CTA revealed patent kissing stent graft”. Comment: Kissing stents are not grafts they are just kissing stents. Positive flow to bilateral femoral artery, bilateral subpopliteal artery, until bilateral malleolus region especially left anterior tibial artery and right posterior tibial artery Comment: Again there is not such a thing as positive flow. There is either presence of flow (monophasic biphasic signal on doppler) or presence or absence of pulses. Please state which one was in your case. There is not an artery called subpopliteal, there are however infrapopliteal artreies (anterio, posterior tibial and peroneal) The sentences have been paraphrased to “Lower extremity CTA revealed patent kissing stent graft at bilateral common iliac artery, positive contrast flow was presence to bilateral femoral artery, bilateral infrapopliteal artreies subpopliteal artery, until bilateral malleolus region especially left anterior tibial artery and right posterior tibial artery.” Discussion 17. Comment: Endovascular techniques is a general term in your first paragraph you should report on the available endovascular techniques including CERAB and unibody endografts. Also update you reference list accordingly - 1. (Bontinis V et al. [2024 (Ref - 1)]) DOI: 10.1016/j.jvs.2023.12.021, 2. (Manaki V et al. [2024 (Ref - 2)]) DOI: 10.1177/15266028241283721 Available endovascular techniques have been mentioned in the paragraph: “Several available reported endovascular techniques for AIOD treatments including covered endovascular reconstruction of the aortic bifurcation (CERAB), unibody bifurcated endografts, and kissing stent technique showed promising patency outcomes.” 18. Sabri et al.15 mentioned that for atherosclerotic aortic bifurcation occlusive disease, covered balloon-expandable kissing stents have greater patency at 2 years compared to bare metal balloon-expandable stents. We used kissing stent technique with covered balloon-expandable stent and showed a very good result. Despite improved blood flow in short-term follow-up by CT scan and duplex ultrasound, long-term follow-up needs to be done for the patient. Comment: Update your references list with the latest IPD meta-analysis describing Covered VS Bare for aotoiliac disea with follow-up intervals up to 10 years (Bontinis V et al. [2024 (Ref - 3)]) 10.1016/j.ejvs.2024.06.008 Reference has been updated mentioning IPD meta-analysis by Bontinis V, et al. “Recent individual participant data meta-analysis by Bontinis, et al. also reported improved 48 months patency of covered stent compared with bare metal stent in the treatment of TASC C and D lesions with 92.4% (95% CI 84.7 – 100%) and 80.8% (95% CI 64.5 – 100%) patency rate respectively.” 19. “ In our case, the patient was a heavy smoker, but he admitted that he just committed to stop smoking. Unfortunately, he had long-standing hypertension and type 2 DM which also were another important risk factor of atherosclerosis process itself. Good teamwork between care provider, patient, and patient’s family should be targeted in this scenario.” Comment: You are presenting a technical manuscript and this is irrelevant in my opinion The paragraph has been removed from the manuscript Conclusion 20. “We had presented a case of a patient with AIOD (Leriche syndrome) TASC II type D which successfully underwent endovascular approach (kissing stent technique) with a good result and blood flow improvement to distal area of lower extremity. Comment : “We presented”, “covered kissing stent technique”, Endovascular management of TASC II type C and D lesions approach is an excellent alternative to the surgical approach The word approach is redundant Comment : the word approach is out of place here The sentences have been paraphrased to “We presented a case of a patient with AIOD (Leriche syndrome) TASC II type D which successfully underwent endovascular treatment utilizing( covered kissing stent technique) with a good result and blood flow improvement to distal area of lower extremity. Endovascular approach of in TASC II type C and D lesions is an excellent alternative to the traditional surgical technique.” Once again, I really appreciate the time and effort that you have invested in reviewing my manuscript. Your insights were helpful, and I am truly grateful for your support and expertise. Please let us know if further revision is needed. Thank you for your contribution to our manuscript. Best regards, Taofan, MD Departement of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia Competing Interests: no ompeting interest Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 06 Nov 2024 Taofan Taofan , Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia / National Cardiovascular Center Harapan Kita / University of Indonesia Academic Hospital, Jakarta, Indonesia 06 Nov 2024 Author Response We would like to thank Dr. Vangelis Bontinis for the constructive insight regarding our manuscript. Here we try to adress and revise our manuscript from Dr. Vangelis Bontinis comments point ... Continue reading We would like to thank Dr. Vangelis Bontinis for the constructive insight regarding our manuscript. Here we try to adress and revise our manuscript from Dr. Vangelis Bontinis comments point by point. Abstract 1. “is a peripheral artery disease, specifically affecting the infrarenal aorta and iliac arteries.” Comment: Rephrase since this English can be improved. A suggestion would be “ .. is a form of peripheral arterial disease involving the….” The sentence has been paraphrased to “Aortoiliac occlusive disease (AIOD) or Leriche syndrome, is a form of peripheral arterial disease involving the infrarenal aorta and iliac arteries.” 2. “Presentation of AIOD patients ranged from asymptomatic to having limb-threatening emergencies “ Rephrase. Comment: “ The presentation of AIOD ranges from asymptomatic cases to limb-threatening emergencies” The sentence has been paraphrased to “The presentation of AIOD ranges from asymptomatic cases to limb-threatening emergencies. 3. “Advances and innovations in endovascular devices have replaced surgical approach for AIOD treatment. Here we reported a 52-year-old man presenting with AIOD managed by endovascular approach using kissing stent technique.” Comment: …”have replaced traditional surgical interventions for the management of AIOD. Here we report a case of a….” The sentences have been paraphrased to “Advances and innovations in endovascular devices have replaced traditional surgical interventions for the management of AIOD. Here we report a case of a 52-year-old man presenting with AIOD managed by endovascular approach using kissing stent technique.” 4. “and who was a heavy smoker” Comment: “and a significant history of smoking”. “long time with bilateral claudication” Comment : “long-standing bilateral claudication which recently progressed to rest pain” The sentence has been paraphrased to “A 52-year-old man, with history of chronic coronary artery disease, diabetes mellitus type 2, long-standing hypertension, and a significant history of smoking, was admitted to our hospital with symptoms of long-standing bilateral claudication which recently progressed to rest pain.” 5. “He had history of aorto-infrarenal occlusion known from previous percutaneous coronary intervention from right and left femoral artery access.” Comment: “A history of aortoiliac occlusive disease (TASC II Type D) was previously established” The sentences have been paraphrased to “A history of AIOD was previously established. AIOD (TASC II Type D) diagnosis was made by lower extremity duplex ultrasound and CT angiography.” 6. optimal medical treatment, Comment “best medical therapy (BMT)” The sentence has been paraphrased to “The patient was discharged 4 days after the procedure without any significant complaints, received best medical therapy.” 7. “Treatment of AIOD should include both modification of risk factors and efforts to increase perfusion to the lower extremities. An endovascular approach is an excellent alternative and may replace surgical approach in complex aortoiliac obstructive disease. In this case report, an endovascular approach with kissing stent technique showed good results for the patient.” Comment: You can’t just pop up a comment about risk modification parameters out of nowhere. Then you just performed a case of a kissing stent you can’t claim that just because of this one case endovascular techniques will surpass surgical interventions. These conclusions are merely grounded on your limited persona experience A suggested rephrase is “Endovascular interventions present excellent alternatives to surgical techniques in the treatment of complex aortoiliac obstructive disease. Herein we presented, an endovascular treatment of AIOD utilizing the kissing stent technique which showcased satisfactory outcomes.” The sentences have been paraphrased to Endovascular interventions present excellent alternatives to surgical techniques in the treatment of complex AIOD. Herein we presented an endovascular treatment of AIOD utilizing the kissing stent technique which showcased satisfactory outcomes. Introduction 8. “is the leading cause of peripheral arterial disease (PAD)” Comment: About 1/3 of PAD cases present with aortoiliac involvement and very few of them are complete occlusions! The most common distribution of PAD lesions involve femoropopliteal lesions! The sentence has been paraphrased to “Aortoiliac occlusive disease (AIOD), also known as Leriche syndrome results from a chronic occlusive process of the infrarenal aorta and iliac arteries and is one of the cause of peripheral arterial disease (PAD).” 9. “ nicotine use, age, sex, and family history” Comment: you mean “male gender” The sentence has been paraphrased to “Risk factors for AIOD include hypertension, hyperglycemia, hyperlipidemia, nicotine use, age, male gender, and family history.” 10. “ Advances and innovations in endovascular devices have replaced standard surgical approach with endovascular approach, including in long and complex lesions. An endovascular approach is currently recommended as the definitive interventional treatment for AIOD” Comment: First avoid repeating the same words within a sentence. Then, no they have not replaced surgical techniques and they are not recommended over surgery. As a matter of fact, this is much more complicated than you suggest with TASC guidelines suggesting endovascular surgery for TASC A and B lesions and surgery for TASC C D lesions (which include occlusions). Additionally, more recent guidelines advocate for endovascular treatment in short lesions or occlusions. So please correct this The sentences have been paraphrased to “Advances and innovations in endovascular devices offered promising alternatives over standard surgical approach, including in long and complex lesions. Endovascular treatment in the aortoiliac segment has shown high technical success and lower complication rates compared to standard surgery. It also provides excellent patency, making it a valuable option to be considered for Trans-Atlantic Inter-Society Consensus (TASC) C and D lesions, especially in patients who are poor candidates for surgery.” Case report 11. “Javanese man” Comment: I believe the authors mean "Japanese" Javanese is an ethnic group from Indonesia. It is who we identify as. 12. “ bilateral leg pain in the” Comment: You mean claudication or rest pain? “He had symptoms of worsening bilateral leg pain in the past year, and felt chest pain sometimes, especially when he was walking for long distances. Another clinical symptom that he had was impotence. “ Comment: This English can be improved and a suggested rephrase would be “Over the past year, the patient experienced progressive bilateral leg pain, accompanied by occasional episodes of chest pain, particularly during prolonged walking. Additionally, the patient reported symptoms of erectile dysfunction.” The sentences have been paraphrased to “Over the past year, the patient experienced long-standing bilateral claudication which recently progressed to rest pain, accompanied by occasional episodes of chest pain, particularly during prolonged walking. Additionally, the patient reported symptoms of erectile dysfunction.” 13. “ The patient had a history of aorto-infrarenal occlusion that was known when he underwent percutaneous coronary intervention (PCI) via the right radial artery but failed after the approach was moved to both sides of femoral artery access because of the occlusion in bilateral common iliac arteries one year earlier. “ Comment: This paragraph fails to provide any clarity unfortunately. In my opinion the fact that he had an attempt to PCI and they it failed is of no true value to the manuscript. You can just state that the patient had known AOID diagnosed following a failed PCI attempt. The sentence has been paraphrased to “The patient had known AOID diagnosed following a failed percutaneous coronary intervention (PCI) attempt.” 14. “ Insertion of 12×95×100 mm bifurcated stent graft extension (Seal®, S&G Biotech, Korea) from the right femoral artery access and 12×75×80 mm bifurcated stent graft extension (Seal®, S&G Biotech, Korea) from the left femoral artery access were done (Figure 2F)” Comment: What I see here are covered stents and not bifurcated grafts which in reality you could not have used so please correct this as this is a major error! It has been corrected to “Insertion of 12×95×100 mm stent graft (Seal ®, S&G Biotech, Korea) from the right femoral artery access and 12×75×80 mm stent graft (Seal ®, S&G Biotech, Korea) from the left femoral artery access were done.” 15, “ The final result of the procedure was positive flow until the distal part of both common femoral” Comment: There is no such thing as a positive or negative flow. Omit this while sentence and just state “Following the intervention abdominal aorta blood pressure was 170 / 79 (114) mmHg, right femoral artery blood pressure was 141/68 (98) mmHg, and left femoral artery blood pressure was 137/77 (102) mmHg” The sentence has been paraphrased to “Following the intervention abdominal aorta blood pressure was 170 / 79 (114) mmHg, right femoral artery blood pressure was 141/68 (98) mmHg, and left femoral artery blood pressure was 137/77 (102) mmHg.” 16. “ Lower extremity CTA revealed patent kissing stent graft”. Comment: Kissing stents are not grafts they are just kissing stents. Positive flow to bilateral femoral artery, bilateral subpopliteal artery, until bilateral malleolus region especially left anterior tibial artery and right posterior tibial artery Comment: Again there is not such a thing as positive flow. There is either presence of flow (monophasic biphasic signal on doppler) or presence or absence of pulses. Please state which one was in your case. There is not an artery called subpopliteal, there are however infrapopliteal artreies (anterio, posterior tibial and peroneal) The sentences have been paraphrased to “Lower extremity CTA revealed patent kissing stent graft at bilateral common iliac artery, positive contrast flow was presence to bilateral femoral artery, bilateral infrapopliteal artreies subpopliteal artery, until bilateral malleolus region especially left anterior tibial artery and right posterior tibial artery.” Discussion 17. Comment: Endovascular techniques is a general term in your first paragraph you should report on the available endovascular techniques including CERAB and unibody endografts. Also update you reference list accordingly - 1. (Bontinis V et al. [2024 (Ref - 1)]) DOI: 10.1016/j.jvs.2023.12.021, 2. (Manaki V et al. [2024 (Ref - 2)]) DOI: 10.1177/15266028241283721 Available endovascular techniques have been mentioned in the paragraph: “Several available reported endovascular techniques for AIOD treatments including covered endovascular reconstruction of the aortic bifurcation (CERAB), unibody bifurcated endografts, and kissing stent technique showed promising patency outcomes.” 18. Sabri et al.15 mentioned that for atherosclerotic aortic bifurcation occlusive disease, covered balloon-expandable kissing stents have greater patency at 2 years compared to bare metal balloon-expandable stents. We used kissing stent technique with covered balloon-expandable stent and showed a very good result. Despite improved blood flow in short-term follow-up by CT scan and duplex ultrasound, long-term follow-up needs to be done for the patient. Comment: Update your references list with the latest IPD meta-analysis describing Covered VS Bare for aotoiliac disea with follow-up intervals up to 10 years (Bontinis V et al. [2024 (Ref - 3)]) 10.1016/j.ejvs.2024.06.008 Reference has been updated mentioning IPD meta-analysis by Bontinis V, et al. “Recent individual participant data meta-analysis by Bontinis, et al. also reported improved 48 months patency of covered stent compared with bare metal stent in the treatment of TASC C and D lesions with 92.4% (95% CI 84.7 – 100%) and 80.8% (95% CI 64.5 – 100%) patency rate respectively.” 19. “ In our case, the patient was a heavy smoker, but he admitted that he just committed to stop smoking. Unfortunately, he had long-standing hypertension and type 2 DM which also were another important risk factor of atherosclerosis process itself. Good teamwork between care provider, patient, and patient’s family should be targeted in this scenario.” Comment: You are presenting a technical manuscript and this is irrelevant in my opinion The paragraph has been removed from the manuscript Conclusion 20. “We had presented a case of a patient with AIOD (Leriche syndrome) TASC II type D which successfully underwent endovascular approach (kissing stent technique) with a good result and blood flow improvement to distal area of lower extremity. Comment : “We presented”, “covered kissing stent technique”, Endovascular management of TASC II type C and D lesions approach is an excellent alternative to the surgical approach The word approach is redundant Comment : the word approach is out of place here The sentences have been paraphrased to “We presented a case of a patient with AIOD (Leriche syndrome) TASC II type D which successfully underwent endovascular treatment utilizing( covered kissing stent technique) with a good result and blood flow improvement to distal area of lower extremity. Endovascular approach of in TASC II type C and D lesions is an excellent alternative to the traditional surgical technique.” Once again, I really appreciate the time and effort that you have invested in reviewing my manuscript. Your insights were helpful, and I am truly grateful for your support and expertise. Please let us know if further revision is needed. Thank you for your contribution to our manuscript. Best regards, Taofan, MD Departement of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia We would like to thank Dr. Vangelis Bontinis for the constructive insight regarding our manuscript. Here we try to adress and revise our manuscript from Dr. Vangelis Bontinis comments point by point. Abstract 1. “is a peripheral artery disease, specifically affecting the infrarenal aorta and iliac arteries.” Comment: Rephrase since this English can be improved. A suggestion would be “ .. is a form of peripheral arterial disease involving the….” The sentence has been paraphrased to “Aortoiliac occlusive disease (AIOD) or Leriche syndrome, is a form of peripheral arterial disease involving the infrarenal aorta and iliac arteries.” 2. “Presentation of AIOD patients ranged from asymptomatic to having limb-threatening emergencies “ Rephrase. Comment: “ The presentation of AIOD ranges from asymptomatic cases to limb-threatening emergencies” The sentence has been paraphrased to “The presentation of AIOD ranges from asymptomatic cases to limb-threatening emergencies. 3. “Advances and innovations in endovascular devices have replaced surgical approach for AIOD treatment. Here we reported a 52-year-old man presenting with AIOD managed by endovascular approach using kissing stent technique.” Comment: …”have replaced traditional surgical interventions for the management of AIOD. Here we report a case of a….” The sentences have been paraphrased to “Advances and innovations in endovascular devices have replaced traditional surgical interventions for the management of AIOD. Here we report a case of a 52-year-old man presenting with AIOD managed by endovascular approach using kissing stent technique.” 4. “and who was a heavy smoker” Comment: “and a significant history of smoking”. “long time with bilateral claudication” Comment : “long-standing bilateral claudication which recently progressed to rest pain” The sentence has been paraphrased to “A 52-year-old man, with history of chronic coronary artery disease, diabetes mellitus type 2, long-standing hypertension, and a significant history of smoking, was admitted to our hospital with symptoms of long-standing bilateral claudication which recently progressed to rest pain.” 5. “He had history of aorto-infrarenal occlusion known from previous percutaneous coronary intervention from right and left femoral artery access.” Comment: “A history of aortoiliac occlusive disease (TASC II Type D) was previously established” The sentences have been paraphrased to “A history of AIOD was previously established. AIOD (TASC II Type D) diagnosis was made by lower extremity duplex ultrasound and CT angiography.” 6. optimal medical treatment, Comment “best medical therapy (BMT)” The sentence has been paraphrased to “The patient was discharged 4 days after the procedure without any significant complaints, received best medical therapy.” 7. “Treatment of AIOD should include both modification of risk factors and efforts to increase perfusion to the lower extremities. An endovascular approach is an excellent alternative and may replace surgical approach in complex aortoiliac obstructive disease. In this case report, an endovascular approach with kissing stent technique showed good results for the patient.” Comment: You can’t just pop up a comment about risk modification parameters out of nowhere. Then you just performed a case of a kissing stent you can’t claim that just because of this one case endovascular techniques will surpass surgical interventions. These conclusions are merely grounded on your limited persona experience A suggested rephrase is “Endovascular interventions present excellent alternatives to surgical techniques in the treatment of complex aortoiliac obstructive disease. Herein we presented, an endovascular treatment of AIOD utilizing the kissing stent technique which showcased satisfactory outcomes.” The sentences have been paraphrased to Endovascular interventions present excellent alternatives to surgical techniques in the treatment of complex AIOD. Herein we presented an endovascular treatment of AIOD utilizing the kissing stent technique which showcased satisfactory outcomes. Introduction 8. “is the leading cause of peripheral arterial disease (PAD)” Comment: About 1/3 of PAD cases present with aortoiliac involvement and very few of them are complete occlusions! The most common distribution of PAD lesions involve femoropopliteal lesions! The sentence has been paraphrased to “Aortoiliac occlusive disease (AIOD), also known as Leriche syndrome results from a chronic occlusive process of the infrarenal aorta and iliac arteries and is one of the cause of peripheral arterial disease (PAD).” 9. “ nicotine use, age, sex, and family history” Comment: you mean “male gender” The sentence has been paraphrased to “Risk factors for AIOD include hypertension, hyperglycemia, hyperlipidemia, nicotine use, age, male gender, and family history.” 10. “ Advances and innovations in endovascular devices have replaced standard surgical approach with endovascular approach, including in long and complex lesions. An endovascular approach is currently recommended as the definitive interventional treatment for AIOD” Comment: First avoid repeating the same words within a sentence. Then, no they have not replaced surgical techniques and they are not recommended over surgery. As a matter of fact, this is much more complicated than you suggest with TASC guidelines suggesting endovascular surgery for TASC A and B lesions and surgery for TASC C D lesions (which include occlusions). Additionally, more recent guidelines advocate for endovascular treatment in short lesions or occlusions. So please correct this The sentences have been paraphrased to “Advances and innovations in endovascular devices offered promising alternatives over standard surgical approach, including in long and complex lesions. Endovascular treatment in the aortoiliac segment has shown high technical success and lower complication rates compared to standard surgery. It also provides excellent patency, making it a valuable option to be considered for Trans-Atlantic Inter-Society Consensus (TASC) C and D lesions, especially in patients who are poor candidates for surgery.” Case report 11. “Javanese man” Comment: I believe the authors mean "Japanese" Javanese is an ethnic group from Indonesia. It is who we identify as. 12. “ bilateral leg pain in the” Comment: You mean claudication or rest pain? “He had symptoms of worsening bilateral leg pain in the past year, and felt chest pain sometimes, especially when he was walking for long distances. Another clinical symptom that he had was impotence. “ Comment: This English can be improved and a suggested rephrase would be “Over the past year, the patient experienced progressive bilateral leg pain, accompanied by occasional episodes of chest pain, particularly during prolonged walking. Additionally, the patient reported symptoms of erectile dysfunction.” The sentences have been paraphrased to “Over the past year, the patient experienced long-standing bilateral claudication which recently progressed to rest pain, accompanied by occasional episodes of chest pain, particularly during prolonged walking. Additionally, the patient reported symptoms of erectile dysfunction.” 13. “ The patient had a history of aorto-infrarenal occlusion that was known when he underwent percutaneous coronary intervention (PCI) via the right radial artery but failed after the approach was moved to both sides of femoral artery access because of the occlusion in bilateral common iliac arteries one year earlier. “ Comment: This paragraph fails to provide any clarity unfortunately. In my opinion the fact that he had an attempt to PCI and they it failed is of no true value to the manuscript. You can just state that the patient had known AOID diagnosed following a failed PCI attempt. The sentence has been paraphrased to “The patient had known AOID diagnosed following a failed percutaneous coronary intervention (PCI) attempt.” 14. “ Insertion of 12×95×100 mm bifurcated stent graft extension (Seal®, S&G Biotech, Korea) from the right femoral artery access and 12×75×80 mm bifurcated stent graft extension (Seal®, S&G Biotech, Korea) from the left femoral artery access were done (Figure 2F)” Comment: What I see here are covered stents and not bifurcated grafts which in reality you could not have used so please correct this as this is a major error! It has been corrected to “Insertion of 12×95×100 mm stent graft (Seal ®, S&G Biotech, Korea) from the right femoral artery access and 12×75×80 mm stent graft (Seal ®, S&G Biotech, Korea) from the left femoral artery access were done.” 15, “ The final result of the procedure was positive flow until the distal part of both common femoral” Comment: There is no such thing as a positive or negative flow. Omit this while sentence and just state “Following the intervention abdominal aorta blood pressure was 170 / 79 (114) mmHg, right femoral artery blood pressure was 141/68 (98) mmHg, and left femoral artery blood pressure was 137/77 (102) mmHg” The sentence has been paraphrased to “Following the intervention abdominal aorta blood pressure was 170 / 79 (114) mmHg, right femoral artery blood pressure was 141/68 (98) mmHg, and left femoral artery blood pressure was 137/77 (102) mmHg.” 16. “ Lower extremity CTA revealed patent kissing stent graft”. Comment: Kissing stents are not grafts they are just kissing stents. Positive flow to bilateral femoral artery, bilateral subpopliteal artery, until bilateral malleolus region especially left anterior tibial artery and right posterior tibial artery Comment: Again there is not such a thing as positive flow. There is either presence of flow (monophasic biphasic signal on doppler) or presence or absence of pulses. Please state which one was in your case. There is not an artery called subpopliteal, there are however infrapopliteal artreies (anterio, posterior tibial and peroneal) The sentences have been paraphrased to “Lower extremity CTA revealed patent kissing stent graft at bilateral common iliac artery, positive contrast flow was presence to bilateral femoral artery, bilateral infrapopliteal artreies subpopliteal artery, until bilateral malleolus region especially left anterior tibial artery and right posterior tibial artery.” Discussion 17. Comment: Endovascular techniques is a general term in your first paragraph you should report on the available endovascular techniques including CERAB and unibody endografts. Also update you reference list accordingly - 1. (Bontinis V et al. [2024 (Ref - 1)]) DOI: 10.1016/j.jvs.2023.12.021, 2. (Manaki V et al. [2024 (Ref - 2)]) DOI: 10.1177/15266028241283721 Available endovascular techniques have been mentioned in the paragraph: “Several available reported endovascular techniques for AIOD treatments including covered endovascular reconstruction of the aortic bifurcation (CERAB), unibody bifurcated endografts, and kissing stent technique showed promising patency outcomes.” 18. Sabri et al.15 mentioned that for atherosclerotic aortic bifurcation occlusive disease, covered balloon-expandable kissing stents have greater patency at 2 years compared to bare metal balloon-expandable stents. We used kissing stent technique with covered balloon-expandable stent and showed a very good result. Despite improved blood flow in short-term follow-up by CT scan and duplex ultrasound, long-term follow-up needs to be done for the patient. Comment: Update your references list with the latest IPD meta-analysis describing Covered VS Bare for aotoiliac disea with follow-up intervals up to 10 years (Bontinis V et al. [2024 (Ref - 3)]) 10.1016/j.ejvs.2024.06.008 Reference has been updated mentioning IPD meta-analysis by Bontinis V, et al. “Recent individual participant data meta-analysis by Bontinis, et al. also reported improved 48 months patency of covered stent compared with bare metal stent in the treatment of TASC C and D lesions with 92.4% (95% CI 84.7 – 100%) and 80.8% (95% CI 64.5 – 100%) patency rate respectively.” 19. “ In our case, the patient was a heavy smoker, but he admitted that he just committed to stop smoking. Unfortunately, he had long-standing hypertension and type 2 DM which also were another important risk factor of atherosclerosis process itself. Good teamwork between care provider, patient, and patient’s family should be targeted in this scenario.” Comment: You are presenting a technical manuscript and this is irrelevant in my opinion The paragraph has been removed from the manuscript Conclusion 20. “We had presented a case of a patient with AIOD (Leriche syndrome) TASC II type D which successfully underwent endovascular approach (kissing stent technique) with a good result and blood flow improvement to distal area of lower extremity. Comment : “We presented”, “covered kissing stent technique”, Endovascular management of TASC II type C and D lesions approach is an excellent alternative to the surgical approach The word approach is redundant Comment : the word approach is out of place here The sentences have been paraphrased to “We presented a case of a patient with AIOD (Leriche syndrome) TASC II type D which successfully underwent endovascular treatment utilizing( covered kissing stent technique) with a good result and blood flow improvement to distal area of lower extremity. Endovascular approach of in TASC II type C and D lesions is an excellent alternative to the traditional surgical technique.” Once again, I really appreciate the time and effort that you have invested in reviewing my manuscript. Your insights were helpful, and I am truly grateful for your support and expertise. Please let us know if further revision is needed. Thank you for your contribution to our manuscript. Best regards, Taofan, MD Departement of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia Competing Interests: no ompeting interest Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Habibie YA. Reviewer Report For: Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient [version 3; peer review: 2 approved] . F1000Research 2024, 12 :477 ( https://doi.org/10.5256/f1000research.168180.r299453 ) The direct URL for this report is: https://f1000research.com/articles/12-477/v2#referee-response-299453 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 15 Jul 2024 Yopie Afriandi Habibie , Department of Surgery, Faculty of Medicine Universitas Syiah Kuala (Ringgold ID: 175503), Banda Aceh, Aceh, Indonesia Approved VIEWS 0 https://doi.org/10.5256/f1000research.168180.r299453 Dear Dr. Taofan and Team I appreciate your dedication to ... Continue reading READ ALL Dear Dr. Taofan and Team I appreciate your dedication to enhancing this manuscript to advance knowledge. Congratulations to Dr. Taofan and the team. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Cardiovascular Medicine, Vascular Surgery, Endovascular, Thoracic Surgery, Cardiac Surgery, Acute Care Surgery, Trauma I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Habibie YA. Reviewer Report For: Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient [version 3; peer review: 2 approved] . F1000Research 2024, 12 :477 ( https://doi.org/10.5256/f1000research.168180.r299453 ) The direct URL for this report is: https://f1000research.com/articles/12-477/v2#referee-response-299453 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 04 Sep 2024 Taofan Taofan , Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia / National Cardiovascular Center Harapan Kita / University of Indonesia Academic Hospital, Jakarta, Indonesia 04 Sep 2024 Author Response Dear Yopie Afriandi Habibie I hope this message finds you well. I wanted to extend my sincere gratitude for your thoughtful and thorough review of my article, “Case Report: ... Continue reading Dear Yopie Afriandi Habibie I hope this message finds you well. I wanted to extend my sincere gratitude for your thoughtful and thorough review of my article, “Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient” which has been approved for publication in F1000research. Your valuable feedback and constructive comments significantly contributed to the enhancement of my work. I greatly appreciate the time and effort you invested in reviewing my manuscript. Your insights were incredibly helpful, and I am truly grateful for your support and expertise. Thank you once again for your contribution to the successful publication of my article. I look forward to any future opportunities for collaboration. Best regards, Taofan, MD Departement of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia Dear Yopie Afriandi Habibie I hope this message finds you well. I wanted to extend my sincere gratitude for your thoughtful and thorough review of my article, “Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient” which has been approved for publication in F1000research. Your valuable feedback and constructive comments significantly contributed to the enhancement of my work. I greatly appreciate the time and effort you invested in reviewing my manuscript. Your insights were incredibly helpful, and I am truly grateful for your support and expertise. Thank you once again for your contribution to the successful publication of my article. I look forward to any future opportunities for collaboration. Best regards, Taofan, MD Departement of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 04 Sep 2024 Taofan Taofan , Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia / National Cardiovascular Center Harapan Kita / University of Indonesia Academic Hospital, Jakarta, Indonesia 04 Sep 2024 Author Response Dear Yopie Afriandi Habibie I hope this message finds you well. I wanted to extend my sincere gratitude for your thoughtful and thorough review of my article, “Case Report: ... Continue reading Dear Yopie Afriandi Habibie I hope this message finds you well. I wanted to extend my sincere gratitude for your thoughtful and thorough review of my article, “Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient” which has been approved for publication in F1000research. Your valuable feedback and constructive comments significantly contributed to the enhancement of my work. I greatly appreciate the time and effort you invested in reviewing my manuscript. Your insights were incredibly helpful, and I am truly grateful for your support and expertise. Thank you once again for your contribution to the successful publication of my article. I look forward to any future opportunities for collaboration. Best regards, Taofan, MD Departement of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia Dear Yopie Afriandi Habibie I hope this message finds you well. I wanted to extend my sincere gratitude for your thoughtful and thorough review of my article, “Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient” which has been approved for publication in F1000research. Your valuable feedback and constructive comments significantly contributed to the enhancement of my work. I greatly appreciate the time and effort you invested in reviewing my manuscript. Your insights were incredibly helpful, and I am truly grateful for your support and expertise. Thank you once again for your contribution to the successful publication of my article. I look forward to any future opportunities for collaboration. Best regards, Taofan, MD Departement of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 09 May 2023 Views 0 Cite How to cite this report: Habibie YA. Reviewer Report For: Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient [version 3; peer review: 2 approved] . F1000Research 2024, 12 :477 ( https://doi.org/10.5256/f1000research.146357.r252298 ) The direct URL for this report is: https://f1000research.com/articles/12-477/v1#referee-response-252298 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 25 May 2024 Yopie Afriandi Habibie , Department of Surgery, Faculty of Medicine Universitas Syiah Kuala (Ringgold ID: 175503), Banda Aceh, Aceh, Indonesia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.146357.r252298 Case Report: 1. Please describe the duration of the symptoms and the specific symptoms experienced by the patient during the course related to the AIOD. 2. Can you provide more specific details about the vascular examination related to ... Continue reading READ ALL Case Report: 1. Please describe the duration of the symptoms and the specific symptoms experienced by the patient during the course related to the AIOD. 2. Can you provide more specific details about the vascular examination related to AIOD? 3. In the third paragraph, please correct the diagnosis to Chronic Limb Threatening Ischemia (TASC II Type D lesion). 4. In the fifth paragraph, please explain how you performed initial orthography in this patient, despite an AIOD? Did you puncture both sides of the Femoral artery? Please explain step by step the procedure before implanting the kissing stent. Also, which wire did you use to penetrate the lesion? For balloon pre-dilatation, which Fr did you use (Fig 2C and D)? 5. Regarding Fig 2H, do you have another image after the final result showing the stent's patency? Discussion 1. Paragraph two last sentence: Please explain your reasoning for choosing primary stenting over selective stenting despite the risks. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Cardiovascular, Vascular & Endovascular Surgery, Vascular Medicine, Thoracic Trauma, Trauma, Stem Cell, Cardiac Surgery, Thoracic Disease, I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Habibie YA. Reviewer Report For: Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient [version 3; peer review: 2 approved] . F1000Research 2024, 12 :477 ( https://doi.org/10.5256/f1000research.146357.r252298 ) The direct URL for this report is: https://f1000research.com/articles/12-477/v1#referee-response-252298 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 04 Jul 2024 Taofan Taofan , Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia / National Cardiovascular Center Harapan Kita / University of Indonesia Academic Hospital, Jakarta, Indonesia 04 Jul 2024 Author Response Thank you for the constructive insight into our article. Here we try to answer and revise some of the questions and notes from the reviewer. Case Report: 1. Please ... Continue reading Thank you for the constructive insight into our article. Here we try to answer and revise some of the questions and notes from the reviewer. Case Report: 1. Please describe the duration of the symptoms and the specific symptoms experienced by the patient during the course related to the AIOD. The patient experienced the symptomps in the past year and his PCI was done one year earlier. 2. Can you provide more specific details about the vascular examination related to AIOD? Lower extremity duplex ultrasound (DUS) suspected significant stenosis of the abdominal aorta at the infra-renal level with high end-diastolic monophasic doppler curve in both external iliac artery and common femoral artery, rounded doppler curve in both popliteal, anterior, and posterior tibial artery, no thrombus in the deep veins in both limbs, and positive arterial flow to distal to both legs. Pletismography examination revealed Rright ABI was 0.42 and left was 0.35, right toe brachial index (TBI) was 0.45 and left 0.49. 3. In the third paragraph, please correct the diagnosis to Chronic Limb Threatening Ischemia (TASC II Type D lesion). The diagnosis has been revised into chronic limb threatening ischaemia (TASC II type D lesion) causing bilateral aortic infrarenal–iliaca occlusion (Leriche syndrome). 4. In the fifth paragraph, please explain how you performed initial orthography in this patient, despite an AIOD? Did you puncture both sides of the Femoral artery? Please explain step by step the procedure before implanting the kissing stent. Also, which wire did you use to penetrate the lesion? For balloon pre-dilatation, which Fr did you use (Fig 2C and D)? A more detailed step by step procedure with the device used has been described in the paragraph. 5. Regarding Fig 2H, do you have another image after the final result showing the stent's patency? We have changed the Fig 2H, hope it can show clearer image of the final result. Discussion 1. Paragraph two last sentence: Please explain your reasoning for choosing primary stenting over selective stenting despite the risks. In our case, we preferred to do the primary stenting for a better long term clinical succes and patency since our patient was presented with extensive aortoiliac lesions (TASC II type D lesion). Once again thanks to Dr. Yopie Afriandi Habibie for the time and effort in reviewing our article, please let us know if further revision is needed. Thank you for the constructive insight into our article. Here we try to answer and revise some of the questions and notes from the reviewer. Case Report: 1. Please describe the duration of the symptoms and the specific symptoms experienced by the patient during the course related to the AIOD. The patient experienced the symptomps in the past year and his PCI was done one year earlier. 2. Can you provide more specific details about the vascular examination related to AIOD? Lower extremity duplex ultrasound (DUS) suspected significant stenosis of the abdominal aorta at the infra-renal level with high end-diastolic monophasic doppler curve in both external iliac artery and common femoral artery, rounded doppler curve in both popliteal, anterior, and posterior tibial artery, no thrombus in the deep veins in both limbs, and positive arterial flow to distal to both legs. Pletismography examination revealed Rright ABI was 0.42 and left was 0.35, right toe brachial index (TBI) was 0.45 and left 0.49. 3. In the third paragraph, please correct the diagnosis to Chronic Limb Threatening Ischemia (TASC II Type D lesion). The diagnosis has been revised into chronic limb threatening ischaemia (TASC II type D lesion) causing bilateral aortic infrarenal–iliaca occlusion (Leriche syndrome). 4. In the fifth paragraph, please explain how you performed initial orthography in this patient, despite an AIOD? Did you puncture both sides of the Femoral artery? Please explain step by step the procedure before implanting the kissing stent. Also, which wire did you use to penetrate the lesion? For balloon pre-dilatation, which Fr did you use (Fig 2C and D)? A more detailed step by step procedure with the device used has been described in the paragraph. 5. Regarding Fig 2H, do you have another image after the final result showing the stent's patency? We have changed the Fig 2H, hope it can show clearer image of the final result. Discussion 1. Paragraph two last sentence: Please explain your reasoning for choosing primary stenting over selective stenting despite the risks. In our case, we preferred to do the primary stenting for a better long term clinical succes and patency since our patient was presented with extensive aortoiliac lesions (TASC II type D lesion). Once again thanks to Dr. Yopie Afriandi Habibie for the time and effort in reviewing our article, please let us know if further revision is needed. Competing Interests: no competing interest Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 04 Jul 2024 Taofan Taofan , Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia / National Cardiovascular Center Harapan Kita / University of Indonesia Academic Hospital, Jakarta, Indonesia 04 Jul 2024 Author Response Thank you for the constructive insight into our article. Here we try to answer and revise some of the questions and notes from the reviewer. Case Report: 1. Please ... Continue reading Thank you for the constructive insight into our article. Here we try to answer and revise some of the questions and notes from the reviewer. Case Report: 1. Please describe the duration of the symptoms and the specific symptoms experienced by the patient during the course related to the AIOD. The patient experienced the symptomps in the past year and his PCI was done one year earlier. 2. Can you provide more specific details about the vascular examination related to AIOD? Lower extremity duplex ultrasound (DUS) suspected significant stenosis of the abdominal aorta at the infra-renal level with high end-diastolic monophasic doppler curve in both external iliac artery and common femoral artery, rounded doppler curve in both popliteal, anterior, and posterior tibial artery, no thrombus in the deep veins in both limbs, and positive arterial flow to distal to both legs. Pletismography examination revealed Rright ABI was 0.42 and left was 0.35, right toe brachial index (TBI) was 0.45 and left 0.49. 3. In the third paragraph, please correct the diagnosis to Chronic Limb Threatening Ischemia (TASC II Type D lesion). The diagnosis has been revised into chronic limb threatening ischaemia (TASC II type D lesion) causing bilateral aortic infrarenal–iliaca occlusion (Leriche syndrome). 4. In the fifth paragraph, please explain how you performed initial orthography in this patient, despite an AIOD? Did you puncture both sides of the Femoral artery? Please explain step by step the procedure before implanting the kissing stent. Also, which wire did you use to penetrate the lesion? For balloon pre-dilatation, which Fr did you use (Fig 2C and D)? A more detailed step by step procedure with the device used has been described in the paragraph. 5. Regarding Fig 2H, do you have another image after the final result showing the stent's patency? We have changed the Fig 2H, hope it can show clearer image of the final result. Discussion 1. Paragraph two last sentence: Please explain your reasoning for choosing primary stenting over selective stenting despite the risks. In our case, we preferred to do the primary stenting for a better long term clinical succes and patency since our patient was presented with extensive aortoiliac lesions (TASC II type D lesion). Once again thanks to Dr. Yopie Afriandi Habibie for the time and effort in reviewing our article, please let us know if further revision is needed. Thank you for the constructive insight into our article. Here we try to answer and revise some of the questions and notes from the reviewer. Case Report: 1. Please describe the duration of the symptoms and the specific symptoms experienced by the patient during the course related to the AIOD. The patient experienced the symptomps in the past year and his PCI was done one year earlier. 2. Can you provide more specific details about the vascular examination related to AIOD? Lower extremity duplex ultrasound (DUS) suspected significant stenosis of the abdominal aorta at the infra-renal level with high end-diastolic monophasic doppler curve in both external iliac artery and common femoral artery, rounded doppler curve in both popliteal, anterior, and posterior tibial artery, no thrombus in the deep veins in both limbs, and positive arterial flow to distal to both legs. Pletismography examination revealed Rright ABI was 0.42 and left was 0.35, right toe brachial index (TBI) was 0.45 and left 0.49. 3. In the third paragraph, please correct the diagnosis to Chronic Limb Threatening Ischemia (TASC II Type D lesion). The diagnosis has been revised into chronic limb threatening ischaemia (TASC II type D lesion) causing bilateral aortic infrarenal–iliaca occlusion (Leriche syndrome). 4. In the fifth paragraph, please explain how you performed initial orthography in this patient, despite an AIOD? Did you puncture both sides of the Femoral artery? Please explain step by step the procedure before implanting the kissing stent. Also, which wire did you use to penetrate the lesion? For balloon pre-dilatation, which Fr did you use (Fig 2C and D)? A more detailed step by step procedure with the device used has been described in the paragraph. 5. Regarding Fig 2H, do you have another image after the final result showing the stent's patency? We have changed the Fig 2H, hope it can show clearer image of the final result. Discussion 1. Paragraph two last sentence: Please explain your reasoning for choosing primary stenting over selective stenting despite the risks. In our case, we preferred to do the primary stenting for a better long term clinical succes and patency since our patient was presented with extensive aortoiliac lesions (TASC II type D lesion). Once again thanks to Dr. Yopie Afriandi Habibie for the time and effort in reviewing our article, please let us know if further revision is needed. Competing Interests: no competing interest Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 09 May 2023 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 3 (revision) 06 Nov 24 read Version 2 (revision) 04 Jul 24 read read Version 1 09 May 23 read Yopie Afriandi Habibie , Faculty of Medicine Universitas Syiah Kuala (Ringgold ID: 175503), Banda Aceh, Indonesia Vangelis Bontinis , Aristotle University of Thessaloniki, Thessaloniki, Greece Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Bontinis V. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 09 Nov 2024 | for Version 3 Vangelis Bontinis , Aristotle University of Thessaloniki, Thessaloniki, Greece 0 Views copyright © 2024 Bontinis V. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors have adequately addressed my concerns, and I believe the article is now thoroughly updated and suitable for indexing. Competing Interests No competing interests were disclosed. Reviewer Expertise Vascular Surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Bontinis V. Peer Review Report For: Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient [version 3; peer review: 2 approved] . F1000Research 2024, 12 :477 ( https://doi.org/10.5256/f1000research.174143.r338351) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-477/v3#referee-response-338351 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Bontinis V. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 25 Oct 2024 | for Version 2 Vangelis Bontinis , Aristotle University of Thessaloniki, Thessaloniki, Greece 0 Views copyright © 2024 Bontinis V. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions General comments - I commend the authors for presenting an intriguing case. However, the manuscript requires careful grammatical revision, as multiple errors are evident throughout the text. Abstract “is a peripheral artery disease, specifically affecting the infrarenal aorta and iliac arteries.” Comment: Rephrase since this English can be improved. A suggestion would be “ .. is a form of peripheral arterial disease involving the….” “Presentation of AIOD patients ranged from asymptomatic to having limb-threatening emergencies “ Rephrase Comment: “ The presentation of AIOD ranges from asymptomatic cases to limb-threatening emergencies” “Advances and innovations in endovascular devices have replaced surgical approach for AIOD treatment. Here we reported a 52-year-old man presenting with AIOD managed by endovascular approach using kissing stent technique.” Comment: …”have replaced traditional surgical interventions for the management of AIOD. Here we report a case of a….” “and who was a heavy smoker” Comment: “and a significant history of smoking” “long time with bilateral claudication” Comment : “long-standing bilateral claudication which recently progressed to rest pain” “He had history of aorto-infrarenal occlusion known from previous percutaneous coronary intervention from right and left femoral artery access.” Comment: “A history of aortoiliac occlusive disease (TASC II Type D) was previously established” optimal medical treatment Comment “best medical therapy (BMT)” “Treatment of AIOD should include both modification of risk factors and efforts to increase perfusion to the lower extremities. An endovascular approach is an excellent alternative and may replace surgical approach in complex aortoiliac obstructive disease. In this case report, an endovascular approach with kissing stent technique showed good results for the patient.” Comment: You can’t just pop up a comment about risk modification parameters out of nowhere. Then you just performed a case of a kissing stent you can’t claim that just because of this one case endovascular techniques will surpass surgical interventions. These conclusions are merely grounded on your limited persona experience A suggested rephrase is “Endovascular interventions present excellent alternatives to surgical techniques in the treatment of complex aortoiliac obstructive disease. Herein we presented, an endovascular treatment of AIOD utilizing the kissing stent technique which showcased satisfactory outcomes.” Introduction “is the leading cause of peripheral arterial disease (PAD)” Comment: About 1/3 of PAD cases present with aortoiliac involvement and very few of them are complete occlusions! The most common distribution of PAD lesions involve femoropopliteal lesions! “ nicotine use, age, sex, and family history” Comment: you mean “male gender” “ Advances and innovations in endovascular devices have replaced standard surgical approach with endovascular approach, including in long and complex lesions. An endovascular approach is currently recommended as the definitive interventional treatment for AIOD” Comment: First avoid repeating the same words within a sentence. Then, no they have not replaced surgical techniques and they are not recommended over surgery. As a matter of fact, this is much more complicated than you suggest with TASC guidelines suggesting endovascular surgery for TASC A and B lesions and surgery for TASC C D lesions (which include occlusions). Additionally, more recent guidelines advocate for endovascular treatment in short lesions or occlusions. So please correct this Case report “Javanese man” Comment: I believe the authors mean "Japanese" “ bilateral leg pain in the” Comment: You mean claudication or rest pain? “He had symptoms of worsening bilateral leg pain in the past year, and felt chest pain sometimes, especially when he was walking for long distances. Another clinical symptom that he had was impotence. “ Comment: This English can be improved and a suggested rephrase would be “Over the past year, the patient experienced progressive bilateral leg pain, accompanied by occasional episodes of chest pain, particularly during prolonged walking. Additionally, the patient reported symptoms of erectile dysfunction.” “ The patient had a history of aorto-infrarenal occlusion that was known when he underwent percutaneous coronary intervention (PCI) via the right radial artery but failed after the approach was moved to both sides of femoral artery access because of the occlusion in bilateral common iliac arteries one year earlier. “ Comment: This paragraph fails to provide any clarity unfortunately. In my opinion the fact that he had an attempt to PCI and they it failed is of no true value to the manuscript. You can just state that the patient had known AOID diagnosed following a failed PCI attempt. “ Insertion of 12×95×100 mm bifurcated stent graft extension (Seal ® , S&G Biotech, Korea) from the right femoral artery access and 12×75×80 mm bifurcated stent graft extension (Seal ® , S&G Biotech, Korea) from the left femoral artery access were done ( Figure 2F )” Comment: What I see here are covered stents and not bifurcated grafts which in reality you could not have used so please correct this as this is a major error! “ The final result of the procedure was positive flow until the distal part of both common femoral” Comment: There is no such thing as a positive or negative flow. Omit this while sentence and just state “Following the intervention abdominal aorta blood pressure was 170 / 79 (114) mmHg, right femoral artery blood pressure was 141/68 (98) mmHg, and left femoral artery blood pressure was 137/77 (102) mmHg” “ Lower extremity CTA revealed patent kissing stent graft” Comment: Kissing stents are not grafts they are just kissing stents positive flow to bilateral femoral artery, bilateral subpopliteal artery, until bilateral malleolus region especially left anterior tibial artery and right posterior tibial artery Comment: Again there is not such a thing as positive flow. There is either presence of flow (monophasic biphasic signal on doppler) or presence or absence of pulses. Please state which one was in your case. There is not an artery called subpopliteal, there are however infrapopliteal artreies (anterio, posterior tibial and peroneal) Discussion Comment: Endovascular techniques is a general term in your first paragraph you should report on the available endovascular techniques including CERAB and unibody endografts. Also update you reference list accordingly - 1. (Bontinis V et al. [2024 (Ref - 1)]) DOI: 10.1016/j.jvs.2023.12.021, 2. (Manaki V et al. [2024 (Ref - 2)]) DOI: 10.1177/15266028241283721 Sabri et al.15 mentioned that for atherosclerotic aortic bifurcation occlusive disease, covered balloon-expandable kissing stents have greater patency at 2 years compared to bare metal balloon-expandable stents. We used kissing stent technique with covered balloon-expandable stent and showed a very good result. Despite improved blood flow in short-term follow-up by CT scan and duplex ultrasound, long-term follow-up needs to be done for the patient. Comment: Update your references list with the latest IPD meta-analysis describing Covered VS Bare for aotoiliac disea with follow-up intervals up to 10 years (Bontinis V et al. [2024 (Ref - 3)]) 10.1016/j.ejvs.2024.06.008 “ In our case, the patient was a heavy smoker, but he admitted that he just committed to stop smoking. Unfortunately, he had long-standing hypertension and type 2 DM which also were another important risk factor of atherosclerosis process itself. Good teamwork between care provider, patient, and patient’s family should be targeted in this scenario.” Comment: You are presenting a technical manuscript and this is irrelevant in my opinion Conclusion “We had presented a case of a patient with AIOD (Leriche syndrome) TASC II type D which successfully underwent endovascular approach (kissing stent technique) with a good result and blood flow improvement to distal area of lower extremity. Comment : “We presented”, “covered kissing stent technique”, Endovascular management of TASC II type C and D lesions approach is an excellent alternative to the surgical approach The word approach is redundant Comment : the word approach is out of place here Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Partly References 1. Bontinis V, Bontinis A, Giannopoulos A, Manaki V, et al.: Covered endovascular reconstruction of the aortic bifurcation: A systematic review aggregated data and individual participant data meta-analysis. J Vasc Surg . 2024; 79 (6): 1525-1535.e9 PubMed Abstract | Publisher Full Text 2. Manaki V, Bontinis V, Bontinis A, Giannopoulos A, et al.: Bifurcated Endografts for the Treatment of Aortoiliac Disease a Systematic Review and Individual Patient Data (IPD) Meta-Analysis. J Endovasc Ther . 2024. 15266028241283721 PubMed Abstract | Publisher Full Text 3. Bontinis V, Bontinis A, Giannopoulos A, Manaki V, et al.: Editor's Choice - Covered Stents Versus Bare Metal Stents in the Treatment of Aorto-iliac Disease: A Systematic Review and Individual Participant Data Meta-analysis. Eur J Vasc Endovasc Surg . 2024; 68 (3): 348-358 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Vascular Surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 06 Nov 2024 Taofan Taofan, Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia / National Cardiovascular Center Harapan Kita / University of Indonesia Academic Hospital, Jakarta, Indonesia We would like to thank Dr. Vangelis Bontinis for the constructive insight regarding our manuscript. Here we try to adress and revise our manuscript from Dr. Vangelis Bontinis comments point by point. Abstract 1. “is a peripheral artery disease, specifically affecting the infrarenal aorta and iliac arteries.” Comment: Rephrase since this English can be improved. A suggestion would be “ .. is a form of peripheral arterial disease involving the….” The sentence has been paraphrased to “Aortoiliac occlusive disease (AIOD) or Leriche syndrome, is a form of peripheral arterial disease involving the infrarenal aorta and iliac arteries.” 2. “Presentation of AIOD patients ranged from asymptomatic to having limb-threatening emergencies “ Rephrase. Comment: “ The presentation of AIOD ranges from asymptomatic cases to limb-threatening emergencies” The sentence has been paraphrased to “The presentation of AIOD ranges from asymptomatic cases to limb-threatening emergencies. 3. “Advances and innovations in endovascular devices have replaced surgical approach for AIOD treatment. Here we reported a 52-year-old man presenting with AIOD managed by endovascular approach using kissing stent technique.” Comment: …”have replaced traditional surgical interventions for the management of AIOD. Here we report a case of a….” The sentences have been paraphrased to “Advances and innovations in endovascular devices have replaced traditional surgical interventions for the management of AIOD. Here we report a case of a 52-year-old man presenting with AIOD managed by endovascular approach using kissing stent technique.” 4. “and who was a heavy smoker” Comment: “and a significant history of smoking”. “long time with bilateral claudication” Comment : “long-standing bilateral claudication which recently progressed to rest pain” The sentence has been paraphrased to “A 52-year-old man, with history of chronic coronary artery disease, diabetes mellitus type 2, long-standing hypertension, and a significant history of smoking, was admitted to our hospital with symptoms of long-standing bilateral claudication which recently progressed to rest pain.” 5. “He had history of aorto-infrarenal occlusion known from previous percutaneous coronary intervention from right and left femoral artery access.” Comment: “A history of aortoiliac occlusive disease (TASC II Type D) was previously established” The sentences have been paraphrased to “A history of AIOD was previously established. AIOD (TASC II Type D) diagnosis was made by lower extremity duplex ultrasound and CT angiography.” 6. optimal medical treatment, Comment “best medical therapy (BMT)” The sentence has been paraphrased to “The patient was discharged 4 days after the procedure without any significant complaints, received best medical therapy.” 7. “Treatment of AIOD should include both modification of risk factors and efforts to increase perfusion to the lower extremities. An endovascular approach is an excellent alternative and may replace surgical approach in complex aortoiliac obstructive disease. In this case report, an endovascular approach with kissing stent technique showed good results for the patient.” Comment: You can’t just pop up a comment about risk modification parameters out of nowhere. Then you just performed a case of a kissing stent you can’t claim that just because of this one case endovascular techniques will surpass surgical interventions. These conclusions are merely grounded on your limited persona experience A suggested rephrase is “Endovascular interventions present excellent alternatives to surgical techniques in the treatment of complex aortoiliac obstructive disease. Herein we presented, an endovascular treatment of AIOD utilizing the kissing stent technique which showcased satisfactory outcomes.” The sentences have been paraphrased to Endovascular interventions present excellent alternatives to surgical techniques in the treatment of complex AIOD. Herein we presented an endovascular treatment of AIOD utilizing the kissing stent technique which showcased satisfactory outcomes. Introduction 8. “is the leading cause of peripheral arterial disease (PAD)” Comment: About 1/3 of PAD cases present with aortoiliac involvement and very few of them are complete occlusions! The most common distribution of PAD lesions involve femoropopliteal lesions! The sentence has been paraphrased to “Aortoiliac occlusive disease (AIOD), also known as Leriche syndrome results from a chronic occlusive process of the infrarenal aorta and iliac arteries and is one of the cause of peripheral arterial disease (PAD).” 9. “ nicotine use, age, sex, and family history” Comment: you mean “male gender” The sentence has been paraphrased to “Risk factors for AIOD include hypertension, hyperglycemia, hyperlipidemia, nicotine use, age, male gender, and family history.” 10. “ Advances and innovations in endovascular devices have replaced standard surgical approach with endovascular approach, including in long and complex lesions. An endovascular approach is currently recommended as the definitive interventional treatment for AIOD” Comment: First avoid repeating the same words within a sentence. Then, no they have not replaced surgical techniques and they are not recommended over surgery. As a matter of fact, this is much more complicated than you suggest with TASC guidelines suggesting endovascular surgery for TASC A and B lesions and surgery for TASC C D lesions (which include occlusions). Additionally, more recent guidelines advocate for endovascular treatment in short lesions or occlusions. So please correct this The sentences have been paraphrased to “Advances and innovations in endovascular devices offered promising alternatives over standard surgical approach, including in long and complex lesions. Endovascular treatment in the aortoiliac segment has shown high technical success and lower complication rates compared to standard surgery. It also provides excellent patency, making it a valuable option to be considered for Trans-Atlantic Inter-Society Consensus (TASC) C and D lesions, especially in patients who are poor candidates for surgery.” Case report 11. “Javanese man” Comment: I believe the authors mean "Japanese" Javanese is an ethnic group from Indonesia. It is who we identify as. 12. “ bilateral leg pain in the” Comment: You mean claudication or rest pain? “He had symptoms of worsening bilateral leg pain in the past year, and felt chest pain sometimes, especially when he was walking for long distances. Another clinical symptom that he had was impotence. “ Comment: This English can be improved and a suggested rephrase would be “Over the past year, the patient experienced progressive bilateral leg pain, accompanied by occasional episodes of chest pain, particularly during prolonged walking. Additionally, the patient reported symptoms of erectile dysfunction.” The sentences have been paraphrased to “Over the past year, the patient experienced long-standing bilateral claudication which recently progressed to rest pain, accompanied by occasional episodes of chest pain, particularly during prolonged walking. Additionally, the patient reported symptoms of erectile dysfunction.” 13. “ The patient had a history of aorto-infrarenal occlusion that was known when he underwent percutaneous coronary intervention (PCI) via the right radial artery but failed after the approach was moved to both sides of femoral artery access because of the occlusion in bilateral common iliac arteries one year earlier. “ Comment: This paragraph fails to provide any clarity unfortunately. In my opinion the fact that he had an attempt to PCI and they it failed is of no true value to the manuscript. You can just state that the patient had known AOID diagnosed following a failed PCI attempt. The sentence has been paraphrased to “The patient had known AOID diagnosed following a failed percutaneous coronary intervention (PCI) attempt.” 14. “ Insertion of 12×95×100 mm bifurcated stent graft extension (Seal®, S&G Biotech, Korea) from the right femoral artery access and 12×75×80 mm bifurcated stent graft extension (Seal®, S&G Biotech, Korea) from the left femoral artery access were done (Figure 2F)” Comment: What I see here are covered stents and not bifurcated grafts which in reality you could not have used so please correct this as this is a major error! It has been corrected to “Insertion of 12×95×100 mm stent graft (Seal ®, S&G Biotech, Korea) from the right femoral artery access and 12×75×80 mm stent graft (Seal ®, S&G Biotech, Korea) from the left femoral artery access were done.” 15, “ The final result of the procedure was positive flow until the distal part of both common femoral” Comment: There is no such thing as a positive or negative flow. Omit this while sentence and just state “Following the intervention abdominal aorta blood pressure was 170 / 79 (114) mmHg, right femoral artery blood pressure was 141/68 (98) mmHg, and left femoral artery blood pressure was 137/77 (102) mmHg” The sentence has been paraphrased to “Following the intervention abdominal aorta blood pressure was 170 / 79 (114) mmHg, right femoral artery blood pressure was 141/68 (98) mmHg, and left femoral artery blood pressure was 137/77 (102) mmHg.” 16. “ Lower extremity CTA revealed patent kissing stent graft”. Comment: Kissing stents are not grafts they are just kissing stents. Positive flow to bilateral femoral artery, bilateral subpopliteal artery, until bilateral malleolus region especially left anterior tibial artery and right posterior tibial artery Comment: Again there is not such a thing as positive flow. There is either presence of flow (monophasic biphasic signal on doppler) or presence or absence of pulses. Please state which one was in your case. There is not an artery called subpopliteal, there are however infrapopliteal artreies (anterio, posterior tibial and peroneal) The sentences have been paraphrased to “Lower extremity CTA revealed patent kissing stent graft at bilateral common iliac artery, positive contrast flow was presence to bilateral femoral artery, bilateral infrapopliteal artreies subpopliteal artery, until bilateral malleolus region especially left anterior tibial artery and right posterior tibial artery.” Discussion 17. Comment: Endovascular techniques is a general term in your first paragraph you should report on the available endovascular techniques including CERAB and unibody endografts. Also update you reference list accordingly - 1. (Bontinis V et al. [2024 (Ref - 1)]) DOI: 10.1016/j.jvs.2023.12.021, 2. (Manaki V et al. [2024 (Ref - 2)]) DOI: 10.1177/15266028241283721 Available endovascular techniques have been mentioned in the paragraph: “Several available reported endovascular techniques for AIOD treatments including covered endovascular reconstruction of the aortic bifurcation (CERAB), unibody bifurcated endografts, and kissing stent technique showed promising patency outcomes.” 18. Sabri et al.15 mentioned that for atherosclerotic aortic bifurcation occlusive disease, covered balloon-expandable kissing stents have greater patency at 2 years compared to bare metal balloon-expandable stents. We used kissing stent technique with covered balloon-expandable stent and showed a very good result. Despite improved blood flow in short-term follow-up by CT scan and duplex ultrasound, long-term follow-up needs to be done for the patient. Comment: Update your references list with the latest IPD meta-analysis describing Covered VS Bare for aotoiliac disea with follow-up intervals up to 10 years (Bontinis V et al. [2024 (Ref - 3)]) 10.1016/j.ejvs.2024.06.008 Reference has been updated mentioning IPD meta-analysis by Bontinis V, et al. “Recent individual participant data meta-analysis by Bontinis, et al. also reported improved 48 months patency of covered stent compared with bare metal stent in the treatment of TASC C and D lesions with 92.4% (95% CI 84.7 – 100%) and 80.8% (95% CI 64.5 – 100%) patency rate respectively.” 19. “ In our case, the patient was a heavy smoker, but he admitted that he just committed to stop smoking. Unfortunately, he had long-standing hypertension and type 2 DM which also were another important risk factor of atherosclerosis process itself. Good teamwork between care provider, patient, and patient’s family should be targeted in this scenario.” Comment: You are presenting a technical manuscript and this is irrelevant in my opinion The paragraph has been removed from the manuscript Conclusion 20. “We had presented a case of a patient with AIOD (Leriche syndrome) TASC II type D which successfully underwent endovascular approach (kissing stent technique) with a good result and blood flow improvement to distal area of lower extremity. Comment : “We presented”, “covered kissing stent technique”, Endovascular management of TASC II type C and D lesions approach is an excellent alternative to the surgical approach The word approach is redundant Comment : the word approach is out of place here The sentences have been paraphrased to “We presented a case of a patient with AIOD (Leriche syndrome) TASC II type D which successfully underwent endovascular treatment utilizing( covered kissing stent technique) with a good result and blood flow improvement to distal area of lower extremity. Endovascular approach of in TASC II type C and D lesions is an excellent alternative to the traditional surgical technique.” Once again, I really appreciate the time and effort that you have invested in reviewing my manuscript. Your insights were helpful, and I am truly grateful for your support and expertise. Please let us know if further revision is needed. Thank you for your contribution to our manuscript. Best regards, Taofan, MD Departement of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia View more View less Competing Interests no ompeting interest reply Respond Report a concern Bontinis V. Peer Review Report For: Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient [version 3; peer review: 2 approved] . F1000Research 2024, 12 :477 ( https://doi.org/10.5256/f1000research.168180.r333171) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-477/v2#referee-response-333171 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Habibie Y. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 15 Jul 2024 | for Version 2 Yopie Afriandi Habibie , Department of Surgery, Faculty of Medicine Universitas Syiah Kuala (Ringgold ID: 175503), Banda Aceh, Aceh, Indonesia 0 Views copyright © 2024 Habibie Y. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Dear Dr. Taofan and Team I appreciate your dedication to enhancing this manuscript to advance knowledge. Congratulations to Dr. Taofan and the team. Competing Interests No competing interests were disclosed. Reviewer Expertise Cardiovascular Medicine, Vascular Surgery, Endovascular, Thoracic Surgery, Cardiac Surgery, Acute Care Surgery, Trauma I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 04 Sep 2024 Taofan Taofan, Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia / National Cardiovascular Center Harapan Kita / University of Indonesia Academic Hospital, Jakarta, Indonesia Dear Yopie Afriandi Habibie I hope this message finds you well. I wanted to extend my sincere gratitude for your thoughtful and thorough review of my article, “Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient” which has been approved for publication in F1000research. Your valuable feedback and constructive comments significantly contributed to the enhancement of my work. I greatly appreciate the time and effort you invested in reviewing my manuscript. Your insights were incredibly helpful, and I am truly grateful for your support and expertise. Thank you once again for your contribution to the successful publication of my article. I look forward to any future opportunities for collaboration. Best regards, Taofan, MD Departement of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Habibie YA. Peer Review Report For: Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient [version 3; peer review: 2 approved] . F1000Research 2024, 12 :477 ( https://doi.org/10.5256/f1000research.168180.r299453) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-477/v2#referee-response-299453 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Habibie Y. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 25 May 2024 | for Version 1 Yopie Afriandi Habibie , Department of Surgery, Faculty of Medicine Universitas Syiah Kuala (Ringgold ID: 175503), Banda Aceh, Aceh, Indonesia 0 Views copyright © 2024 Habibie Y. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Case Report: 1. Please describe the duration of the symptoms and the specific symptoms experienced by the patient during the course related to the AIOD. 2. Can you provide more specific details about the vascular examination related to AIOD? 3. In the third paragraph, please correct the diagnosis to Chronic Limb Threatening Ischemia (TASC II Type D lesion). 4. In the fifth paragraph, please explain how you performed initial orthography in this patient, despite an AIOD? Did you puncture both sides of the Femoral artery? Please explain step by step the procedure before implanting the kissing stent. Also, which wire did you use to penetrate the lesion? For balloon pre-dilatation, which Fr did you use (Fig 2C and D)? 5. Regarding Fig 2H, do you have another image after the final result showing the stent's patency? Discussion 1. Paragraph two last sentence: Please explain your reasoning for choosing primary stenting over selective stenting despite the risks. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Cardiovascular, Vascular & Endovascular Surgery, Vascular Medicine, Thoracic Trauma, Trauma, Stem Cell, Cardiac Surgery, Thoracic Disease, I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 04 Jul 2024 Taofan Taofan, Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia / National Cardiovascular Center Harapan Kita / University of Indonesia Academic Hospital, Jakarta, Indonesia Thank you for the constructive insight into our article. Here we try to answer and revise some of the questions and notes from the reviewer. Case Report: 1. Please describe the duration of the symptoms and the specific symptoms experienced by the patient during the course related to the AIOD. The patient experienced the symptomps in the past year and his PCI was done one year earlier. 2. Can you provide more specific details about the vascular examination related to AIOD? Lower extremity duplex ultrasound (DUS) suspected significant stenosis of the abdominal aorta at the infra-renal level with high end-diastolic monophasic doppler curve in both external iliac artery and common femoral artery, rounded doppler curve in both popliteal, anterior, and posterior tibial artery, no thrombus in the deep veins in both limbs, and positive arterial flow to distal to both legs. Pletismography examination revealed Rright ABI was 0.42 and left was 0.35, right toe brachial index (TBI) was 0.45 and left 0.49. 3. In the third paragraph, please correct the diagnosis to Chronic Limb Threatening Ischemia (TASC II Type D lesion). The diagnosis has been revised into chronic limb threatening ischaemia (TASC II type D lesion) causing bilateral aortic infrarenal–iliaca occlusion (Leriche syndrome). 4. In the fifth paragraph, please explain how you performed initial orthography in this patient, despite an AIOD? Did you puncture both sides of the Femoral artery? Please explain step by step the procedure before implanting the kissing stent. Also, which wire did you use to penetrate the lesion? For balloon pre-dilatation, which Fr did you use (Fig 2C and D)? A more detailed step by step procedure with the device used has been described in the paragraph. 5. Regarding Fig 2H, do you have another image after the final result showing the stent's patency? We have changed the Fig 2H, hope it can show clearer image of the final result. Discussion 1. Paragraph two last sentence: Please explain your reasoning for choosing primary stenting over selective stenting despite the risks. In our case, we preferred to do the primary stenting for a better long term clinical succes and patency since our patient was presented with extensive aortoiliac lesions (TASC II type D lesion). Once again thanks to Dr. Yopie Afriandi Habibie for the time and effort in reviewing our article, please let us know if further revision is needed. View more View less Competing Interests no competing interest reply Respond Report a concern Habibie YA. Peer Review Report For: Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient [version 3; peer review: 2 approved] . F1000Research 2024, 12 :477 ( https://doi.org/10.5256/f1000research.146357.r252298) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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