Failure of endovascular abdominal aortic aneurysm graft limbs

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Presentation transcript:

Failure of endovascular abdominal aortic aneurysm graft limbs Jeffrey P. Carpenter, MDa, David G. Neschis, MDa, Ronald M. Fairman, MDa, Clyde F. Barker, MDa, Michael A. Golden, MDa, Omaida C. Velazquez, MDa, Marc E. Mitchell, MDa, Richard A. Baum, MDb Journal of Vascular Surgery Volume 33, Issue 2, Pages 296-303 (February 2001) DOI: 10.1067/mva.2001.112700 Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 1 Assisted primary patency with stenting of unsupported graft limbs intraoperatively. A, Intraoperative arteriogram performed with a marker catheter (1-cm calibrations) before unsupported graft deployment shows the aortic and left common iliac artery aneurysms. After uneventful graft deployment, a completion arteriogram (B) shows no flow into the left limb of the bifurcated graft (note presence of embolization balloon previously placed in left hypogastric artery). Placement of a Wallstent (14 × 40 mm) into left limb restored its patency but caused right limb to fail by compressing it at aortic bifurcation; thus both limbs were fully stented (plain x-ray film showing stents in limbs [C] ) to obtain assisted primary patency (final arteriogram [D] ). Journal of Vascular Surgery 2001 33, 296-303DOI: (10.1067/mva.2001.112700) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 2 Secondary patency of thrombosed endograft limbs was achieved with mechanical or chemical thrombolysis. The patient shown had received an unsupported bifurcated graft 5 days before readmission for an acutely ischemic right leg. At the initial procedure, a Wallstent was required for left endograft limb to achieve assisted primary patency. Aortography (A) revealed a thrombosed right endograft limb. Selective right limb injection showed multiple stenotic regions and thrombus (B), which were treated with catheter-directed thrombolytic therapy. The limb was subsequently stented to maintain patency. Journal of Vascular Surgery 2001 33, 296-303DOI: (10.1067/mva.2001.112700) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 3 Femorofemoral bypass graft patency comparison for patients with occlusive disease versus patients with aortic aneurysm disease in conjunction with aortomonoiliac endograft. Primary patency at 18 months was 92% for aneurysm patients and 83% for occlusive disease patients (P =.37). Journal of Vascular Surgery 2001 33, 296-303DOI: (10.1067/mva.2001.112700) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 4 Comparison of patency of endograft limbs: bifurcated versus aortomonoiliac designs. Primary patency of bifurcated graft limbs at 18 months was 90%, and aortomonoiliac limbs was 97% (P =.28). Secondary patency was achieved in all cases. Journal of Vascular Surgery 2001 33, 296-303DOI: (10.1067/mva.2001.112700) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 5 Comparison of patency of endograft limbs: supported (thick line ) versus unsupported (thin line ) designs. Primary patency of supported graft limbs at 18 months was 97% and unsupported limbs 69% (P <.001). Assisted primary patency (not shown) for supported limbs was 99% and unsupported 91% (P =.01). Secondary patency was achieved in all cases. Journal of Vascular Surgery 2001 33, 296-303DOI: (10.1067/mva.2001.112700) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions