Endovascular repair of para-anastomotic aneurysms of the aorta and iliac arteries: Preferred treatment for a complex problem Nicholas J. Morrissey, MD*,

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Presentation transcript:

Endovascular repair of para-anastomotic aneurysms of the aorta and iliac arteries: Preferred treatment for a complex problem Nicholas J. Morrissey, MD*, Osvaldo J. Yano, MD, Krish Soundararajan, MD, Leon Eisen, MD, Claudie McArthur, MD, Victoria Teodorescu, MD, Morris Kerstein, MD, Larry Hollier, MD, Michael L. Marin, MD Journal of Vascular Surgery Volume 34, Issue 3, Pages 503-512 (September 2001) DOI: 10.1067/mva.2001.114811 Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 1 Examples of some devices used to exclude PAAs in this series. A, Parodi-Palmaz aortouniiliac stent-graft. B, Gore Excluder Thoracic endoprosthesis. C, World Medical Talent modular bifurcated endoprosthesis. Journal of Vascular Surgery 2001 34, 503-512DOI: (10.1067/mva.2001.114811) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 2 Diagram demonstrating aortouniiliac device. Iliac occluder in the left common iliac prevents retrograde perfusion of PAA. Femoral-femoral crossover graft restores flow to lower extremity and pelvis. Journal of Vascular Surgery 2001 34, 503-512DOI: (10.1067/mva.2001.114811) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 3 A, Schematic representation of proximal aortic PAA. B, Schematic of lesion in A with tube stent-graft in place. Note transrenal placement of a bare stent to allow suprarenal fixation of device. PAA, Para-anastomotic aneurysm. Journal of Vascular Surgery 2001 34, 503-512DOI: (10.1067/mva.2001.114811) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 4 A, Schematic representation of combined proximal and distal aortic PAAs. B, Schematic of lesions in A excluded with bifurcated stent-graft. PAA, Para-anastomotic aneurysm. Journal of Vascular Surgery 2001 34, 503-512DOI: (10.1067/mva.2001.114811) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 5 A, Schematic representation of common iliac artery PAA involving orifice of hypogastric artery. B, Schematic of tube stent-graft excluding the lesion in A. Note coils in hypogastric artery to prevent retrograde perfusion of PAA. PAA, Para-anastomotic aneurysm. Journal of Vascular Surgery 2001 34, 503-512DOI: (10.1067/mva.2001.114811) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 6 A, Left common iliac artery PAA arising at anastomosis of bifurcated polyester fiber (Dacron) graft. B, Exclusion of the lesion in A with a tube stent-graft. Left hypogastric artery has been embolized with coils. PAA, Para-anastomotic aneurysm. Journal of Vascular Surgery 2001 34, 503-512DOI: (10.1067/mva.2001.114811) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 7 A, Schematic representation of bilateral common iliac artery PAAs. B, Schematic representation of exclusion of lesions in A with bifurcated stent-graft. Coil embolization of both hypogastric arteries was performed before surgery. PAA, Para-anastomotic aneurysm Journal of Vascular Surgery 2001 34, 503-512DOI: (10.1067/mva.2001.114811) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 8 A, Combined proximal aortic and common iliac artery PAAs. B, Schematic representation of exclusion of lesions in A with bifurcated stent-graft. Journal of Vascular Surgery 2001 34, 503-512DOI: (10.1067/mva.2001.114811) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 9 A, Computed tomography scan demonstrating 7.5-cm proximal aortic PAA in 65-year-old man with coronary artery disease. B, Angiogram showing PAA and renal arteries. C, Intraoperative angiogram showing stent-graft in place with exclusion of PAA, but with maintenance of renal artery perfusion. D, Postoperative computed tomography scan shows stent-graft in place with no endoleak. Journal of Vascular Surgery 2001 34, 503-512DOI: (10.1067/mva.2001.114811) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 10 Computed tomography scan after stent-graft repair of thoracic PAA in patient with chronic dissection. Note presence of endoleak, as evidenced by means of contrast enhancement of PAA sac. Journal of Vascular Surgery 2001 34, 503-512DOI: (10.1067/mva.2001.114811) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions