Dear Editor, A 77-year-old white male presented with symptoms of claudication had ankle brachial indices (ABI) in the range of 0.5 bilaterally at rest. A peripheral angiogram by accessing right groin was done which revealed ostial 80-90% lesion in the right common iliac artery and 90-95% lesion in the left common iliac artery (Figure 1). The left femoral artery was punctured, and a sheath was advanced. Both lesions were wired with a stiff glidewire. A 5mm x 4 cm balloon was advanced and simultaneous kissing balloon inflation was done in both ostia of the common iliac arteries. Post inflation there was about 50% residual. A 7 x 27 mm Express stent advanced to the right common iliac artery lesion and a 7 x 23 mm Genesis stent was advanced to the left common iliac artery lesion. Simultaneous deployment of the stents was done at 6 atmospheres. A 9 x 2 cm balloon used to post-dilate the left common iliac stent with a good result (Figure 2). Patient had total relief of symptoms. As seen in this patient, ABI's below 0.5 correlate with severe anatomical lesions (1). Key words: Peripheral artery disease, kissing balloon, stenting

Dear Editor,A 77-year-old white male presented with symptoms of claudication had ankle brachial indices (ABI) in therange of 0.5 bilaterally at rest. A lower extremity angiogram by accessing right groin was done which revealedostial 90-95% lesion in the right common iliac artery and 80-90% lesion in the left common iliac artery (Figure1). The left femoral artery was punctured, and a sheath was advanced. Both lesions were wired with a stiffglidewire. A 5mm x 4 cm balloon was advanced and simultaneous kissing balloon inflation was done inboth ostia of the common iliac arteries. Post inflation there was about 50% residual. A 7 x 27 mm balloonexpandable stent advanced to the right common iliac artery lesion and a 7 x 23 mm balloon expandable stentwas advanced to the left common iliac artery lesion. Simultaneous deployment of the stents was done at 6atmospheres. A 9 x 2 cm balloon used to post-dilate the left common iliac stent with a good result (Figure2). Patient had total relief of symptoms. As seen in this patient, ABIs below 0.5 correlate with severeanatomical lesions (1).