Occluding aortic endoluminal stent graft combined with extra-anatomic axillofemoral bypass as alternative management of abdominal aortic aneurysms for patients at high risk with complex anatomic features: A preliminary report

• Published in: Journal of vascular surgery 1998-10, Vol.28 (4), p.651-656
• Main Authors: Minh, T.Le, Motte, S., Hoang, A.D., Ferreira, J., Golzarian, J., Dehon, P., Cavenaile, J.C., Michel, P., Guyot, S., Giot, C., Wautrecht, J.C., Dereume, J.P.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aorta - pathology; Aortic Aneurysm, Abdominal - pathology; Aortic Aneurysm, Abdominal - surgery; Axillary Artery - surgery; Biological and medical sciences; Blood Vessel Prosthesis Implantation; Female; Femoral Artery - surgery; Humans; Iliac Artery - pathology; Male; Medical sciences; Stents; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - methods
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/S0741-5214(98)70090-4

Purpose: To describe an exclusion endoluminal technique for management of abdominal aortic aneurysms among high-risk patients with complex anatomic features. Methods: From January 1995 to December 1996, among 143 patients with infrarenal abdominal aortic aneurysm treated by means of endograft placement, 9 (6.3%) had complex aortic or aortoiliac morphologic features. For these patients, the endograft was delivered through a femoral cutdown in an occluding aortoiliac configuration. The contralateral iliac artery was occluded with an iliac endograft. Axillofemoral bypass grafting was performed. Computed tomographic scans were obtained regularly. Results: There was 1 postoperative death of severe arrhythmia. All aneurysms were found to be affected by thrombosis on immediately postoperative computed tomographic scans, except in 1 patient with a proximal leak, which was managed successfully with angiographic embolization. The mean follow-up time was 12 months. Aortic aneurysm diameter decreased from 2 mm at 6 months (2 patients) to 6 mm at 12 months (6 patients). All axillofemoral bypass grafts are patent. Conclusions: Placement of an occluding endograft associated with axillofemoral bypass grafting is a good alternative for patients at high risk with complex anatomic features. Longer-term follow-up study is needed to evaluate this endoluminal technique. (J Vasc Surg 1998;28:651-6.)