Utility and reliability of endovascular aortouniiliac with femorofemoral crossover graft for aortoiliac aneurysmal disease

Abstract

Transfemoral endovascular repair of abdominal aortic aneurysms (AAAs) has proven feasibility and considerable benefits over traditional open repair. 1-3 However, strict anatomic requirements have limited the application of this method of therapy. Indeed, several recent studies suggest that only 10% to 20% of all AAAs are treatable with currently available commercial devices. 4-6 Although inadequate proximal aortic neck length and diameter are generally thought to be the main limitations in endograft placement, adverse iliac anatomy precludes placement in as many as 50% of patients. 5 The use of an aortouniiliac endoprosthesis in combination with a femorofemoral crossover graft would permit an endovascular approach to the broadest array of patients as only one iliac system is required to satisfy anatomic criteria (Fig 1, A). However, enthusiasm for this type of reconstruction has been restrained by apprehension regarding the durability of the femorofemoral bypass graft and the potential for late complications such as graft infection or pseudoaneurysm formation. Furthermore, the consequences of exclusion of one or both internal iliac arteries Utility and reliability of endovascular aortouniiliac with femorofemoral crossover graft for aortoiliac aneurysmal disease Objective: The purpose of this study was to determine the early efficacy of endovascular aortouniiliac stent grafts with femorofemoral bypass graft in the treatment of aortoiliac aneurysmal disease. Methods: We analyzed 51 consecutive patients from January 1997 to March 1999 with a mean follow-up of 15.8 months. Patients ranged in age from 44 to 93 years (mean, 75 years) with a mean aortic aneurysm diameter of 6.2 cm. Technical success was achieved in 50 patients; one patient required conversion to open repair intraoperatively. We placed 28 custom-made and 22 commercial devices. The mean operative time was 223 minutes. The endograft was extended to the external iliac artery in 42% of cases. The contralateral common iliac artery was occluded using either a closed covered stent or intraluminal coils. Results: The median hospital stay was 4 days with an average intensive care unit stay of 0.25 days. There were no operative mortalities. Two patients died during follow-up from unrelated conditions. Endoleaks occurred in 11 patients (22%); seven patients (14%) required intervention (four catheter based, three operative). Other complications occurred in 38% of patients but were largely remote or wound related. One femorofemoral bypass graft occluded immediately postoperatively as a result of an intraprocedural external iliac dissection yielding a 98% primary patency and 100% secondary patency. Clinical success was achieved in 88% of patients. Conclusions: These data suggest that this strategy represents a reliable method of repair of aortoiliac aneurysmal disease and extends the capability of an endoluminal approach to patients with complex iliac anatomy. (J Vasc Surg 2000;31:1135-41.)

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

“…[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%. [16][17][18][19][20][21][22][23][24] Most series, however, do not provide long-term data and do not exclude patients treated for a ruptured AAA. In addition, most reports include patients treated with a variety of aortomonoiliac endografts, which further affects the ability to reach a definite conclusion.…”

“…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%.…”

“…[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%. [16][17][18][19][20][21][22][23][24] Most series, however, do not provide long-term data and do not exclude patients treated for a ruptured AAA.…”

Traitement endovasculaire d’un anévrysme de l’aorte abdominale chez un patient présentant une sténose bilatérale de stents des artères iliaques communes

“…3 Construction of an iliac conduit would have been difficult, given the small area of native artery remaining and the necessity for proximal and distal control risking injury to the stented iliac segments. The utility and durability of an aortouniiliac endograft with femoral-femoral bypass has been well described [4][5][6] and hence was the chosen option in this complex case. This case illustrates the importance of collaboration in the care of vascular patients with complicated conditions.…”

A comparative analysis of the outcomes of aortic cuffs and converters for endovascular graft migration

“…The reported patency rates are only 60% to 80% for patients with occlusive disease, [20][21][22][23] but are 91% to 100% for patients with aneurysmal disease. 20,[24][25][26][27] The difference in patency rates is attributed to the idea that patients with aneurysmal disease have little or no peripheral occlusive disease. In a select few patients with graft migration, reconstruction with a new bifurcated graft is the best treatment option: it provides seal and stability with proximal and distal fixation points, avoids the need for additional femorofemoral bypass, and maintains a bifurcated reconstruction.…”