Endovascular aortoiliac grafts in combination with standard infrainguinal arterial bypasses in the management of limb-threatening ischemia: Preliminary.

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Presentation transcript:

Endovascular aortoiliac grafts in combination with standard infrainguinal arterial bypasses in the management of limb-threatening ischemia: Preliminary report Michael L. Marin, MD, Frank J. Veith, MD, Luis A. Sanchez, MD, Jacob Cynamon, MD, William D. Suggs, MD, Michael L. Schwartz, MD, Richard E. Parsons, MD, Curtis W. Bakal, MD, Ross T. Lyon, MD Journal of Vascular Surgery Volume 22, Issue 3, Pages 316-325 (September 1995) DOI: 10.1016/S0741-5214(95)70147-8 Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Surgical procedure of endovascular grafting: "Up and over" technique. For details, see text. Journal of Vascular Surgery 1995 22, 316-325DOI: (10.1016/S0741-5214(95)70147-8) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Surgical procedure of endovascular grafting: "Up and over" technique. For details, see text. Journal of Vascular Surgery 1995 22, 316-325DOI: (10.1016/S0741-5214(95)70147-8) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Surgical procedure of endovascular grafting: "Up and over" technique. For details, see text. Journal of Vascular Surgery 1995 22, 316-325DOI: (10.1016/S0741-5214(95)70147-8) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Surgical procedure of endovascular grafting: "Up and over" technique. For details, see text. Journal of Vascular Surgery 1995 22, 316-325DOI: (10.1016/S0741-5214(95)70147-8) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Surgical procedure of endovascular grafting: Retrograde technique — For details, see text. Journal of Vascular Surgery 1995 22, 316-325DOI: (10.1016/S0741-5214(95)70147-8) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Distal end of endovascular graft can be anastomosed to patent distal arterial tree in several ways. (1) Type 1, endoluminal anastomosis to femoral artery is performed and separate proximal anastomosis of distal extravascular graft is performed to femoral arteriotomy. (2) Type 2, intravascular anastomosis and proximal anastomosis of distal extravascular graft are included in single anastomotic closure. (3) Type 3, stented graft is brought out through femoral arteriotomy and anastomosed to patent distal superficial femoral artery. From this site distal extension or crossover femorofemoral extension can be performed if necessary. (4) Type 4, endovascular graft is brought out through femoral arteriotomy and anastomosed to patent distal deep femoral artery. Extension to distal arterial tree or to contralateral femoral artery can be performed from this graft if necessary. (5) Type 5, end of endovascular graft is brought out through femoral arteriotomy and distal graft extension is anastomosed end-to-end to this graft, side-to-side to patent distal deep femoral artery and extended further to distal arterial tree. (6) Type 6, endovascular graft is brought out through femoral arteriotomy and can bypass multiple levels of occlusive disease and be anastomosed distally to popliteal or tibial arteries if all femoral vessels are occluded. EG represents endovascular graft; BG represents distal bypass graft; SFA represents superficial femoral artery; DFA represents deep femoral artery; CFA represents common femoral artery. Journal of Vascular Surgery 1995 22, 316-325DOI: (10.1016/S0741-5214(95)70147-8) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Twelve-month life-table cumulative primary patency rates for endovascular and extravascular grafts were 94% and 92%, respectively. Number of grafts at each interval are indicated by numbers in table. Journal of Vascular Surgery 1995 22, 316-325DOI: (10.1016/S0741-5214(95)70147-8) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Sixty-two – year-old woman was admitted with limb-threatening ischemia of left lower extremity. A, Pelvic arteriogram shows diffuse iliac disease on both sides with left external iliac artery occlusion. B, Iliac artery occlusion was corrected by use of endovascular stented graft from proximal common iliac artery to femoral artery, which was extended to popliteal artery. Journal of Vascular Surgery 1995 22, 316-325DOI: (10.1016/S0741-5214(95)70147-8) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Sixty-two – year-old woman was admitted with limb-threatening ischemia of left lower extremity. A, Pelvic arteriogram shows diffuse iliac disease on both sides with left external iliac artery occlusion. B, Iliac artery occlusion was corrected by use of endovascular stented graft from proximal common iliac artery to femoral artery, which was extended to popliteal artery. Journal of Vascular Surgery 1995 22, 316-325DOI: (10.1016/S0741-5214(95)70147-8) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions