Treatment of complex abdominal aortic aneurysms by a combination of endoluminal and extraluminal aortofemoral grafts James May, MS, FRACS, FACS, Geoffrey.

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Presentation transcript:

Treatment of complex abdominal aortic aneurysms by a combination of endoluminal and extraluminal aortofemoral grafts James May, MS, FRACS, FACS, Geoffrey White, FRACS, Richard Waugh, MB, BS, DDR, FRACR, Weiyun Yu, MB, BS, BSc, John Harris, MS, FRACS, FACS Journal of Vascular Surgery Volume 19, Issue 5, Pages 924-933 (May 1994) DOI: 10.1016/S0741-5214(94)70020-6 Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Device consists of two Dacron tube grafts sutured together obliquely and stainless steel stent sutured to larger diameter graft. Journal of Vascular Surgery 1994 19, 924-933DOI: (10.1016/S0741-5214(94)70020-6) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Graft/stent device mounted on balloon catheter and packaged in inner 21F sheath ready for delivery into outer sheath. Journal of Vascular Surgery 1994 19, 924-933DOI: (10.1016/S0741-5214(94)70020-6) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Aortogram from case 1. Centimeter markers on upper end of catheter for accurate measurement of aneurysm. Calcification in aortic wall (arrows) demonstrate that aneurysm extends down to bifurcation. Journal of Vascular Surgery 1994 19, 924-933DOI: (10.1016/S0741-5214(94)70020-6) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 CT scan 0.5 cm above aortic bifurcation from case 1, confirms extent of aneurysm and absence of distal neck. Journal of Vascular Surgery 1994 19, 924-933DOI: (10.1016/S0741-5214(94)70020-6) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 From case 1, illustration demonstrates transluminal placement of aortic graft/stent device via right common iliac artery and revascularization of lower limbs with aorto right femoral graft and crossover graft. Note that larger graft sutured to right common iliac artery as conduit for access has been retained to allow aortofemoral graft to pass through it. Journal of Vascular Surgery 1994 19, 924-933DOI: (10.1016/S0741-5214(94)70020-6) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 From case 2, aortogram demonstrates 6.5 cm AAA with early aneurysmal disease in common iliac arteries. Journal of Vascular Surgery 1994 19, 924-933DOI: (10.1016/S0741-5214(94)70020-6) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 From case 2, illustration demonstrates transluminal placement of graft/stent device via left external iliac artery, which has been transected to allow distal end of aortofemoral graft to be anastomosed end-to-end to left common femoral artery. Right common iliac artery has been occluded with detachable balloon. Journal of Vascular Surgery 1994 19, 924-933DOI: (10.1016/S0741-5214(94)70020-6) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 8 A. From case 2, CT scan with contrast shows stent in neck of aneurysm. B, CT scan with contrast shows normal flow through graft, and presence of thrombus between prosthetic material and aneurysm sac. Journal of Vascular Surgery 1994 19, 924-933DOI: (10.1016/S0741-5214(94)70020-6) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 9 From case 3, duplex scan shows normal flow through graft and obliteration of aneurysm sac by thrombus. Journal of Vascular Surgery 1994 19, 924-933DOI: (10.1016/S0741-5214(94)70020-6) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions