Early results of endovascular aortic aneurysm surgery with aortouniiliac graft, contralateral iliac occlusion, and femorofemoral bypass

Abstract

Endovascular aortouniiliac repair of abdominal aortic aneurysm with Gianturco stent is feasible in both elective and emergency situations. It appears to be minimally traumatic, and the majority of patients deemed to be at high risk for open surgery can safely undergo endovascular repair. However, data on more patients with longer follow-up is required to determine its role in the management of abdominal aortic aneurysm.

Standard and New Treatments for Abdominal Aortic Aneurysms

“…The MEGS graft, although it requires the creation of a femoro-femoral bypass, was useful for treating those patients who were not amenable to treatment with any of the industry-made devices. This advantage has also been observed by others using similar EVG systems 25,26 The reasons for this are 3 fold. First, this graft is the only one that utilizes a balloon-expandable stent (Palmaz; Cordis, Johnson & Johnson, Warren, NJ, USA) for proximal graft attachment.…”

“…[16][17][18][19][20][21][22][23][24][25][26][27][28] EVG repair can be performed through small incisions in the groin and so the postoperative discomfort, length of hospital stay and the time to recover may be lessened substantially. In addition, it is hoped that EVG repair will decrease the morbidity and mortality rates in high-risk patients.…”

Reporting mid- and long-term results of endovascular grafting for abdominal aortic aneurysms using the aortomonoiliac configuration

“…In those patients, the deployment of an aortomonoiliac endograft, followed by a femorofemoral crossover bypass, could overcome the anatomic limitations and successfully exclude the aortic pathology, therefore avoiding open surgical repair. [16][17][18][19][20][21][22][23][24] Several reports have proved that the aortomonoiliac configuration is both feasible and efficacious. [16][17][18][19][20][21][22][23][24] The short-term results are comparable to those that have been reported for bifurcated endoprostheses, and the patency of the unavoidable extra-anatomical femorofemoral bypass is as high as 99%.…”

Abdominal aortic aneurysms

“…Although its longterm durability is yet to be proven, the feasibility and minimally invasive nature of this approach are already apparent (Fig. 3) [16,20,23,25,26]. Standard procedure There are five types of industry-made endovascular grafts and a few "surgeonmade" grafts used in the United States under FDA-approved investigational device exemptions (Fig.…”

“…Complications Although complication rates for endovascular repair may be comparable to those for standard repair, the complications are less severe. Complications unique to endovascular repair are endoleak, postimplantation syndrome, and arterial rupture [16- 18,19•, [20][21][22][23][24][25][26]. An endoleak indicates that the aneurysm is not completely excluded from the arterial circulation and that the risk for subsequent rupture remains.…”