title: Initial experience with transluminally placed endovascular grafts for the treatment of complex vascular lesions.
abstract: OBJECTIVE
  Complex arterial occlusive, traumatic, and aneurysmal lesions may be difficult or impossible to treat successfully by standard surgical techniques when severe medical or surgical comorbidities exist. The authors describe a single center's experience over a 2 1/2-year period with 96 endovascular graft procedures performed to treat 100 arterial lesions in 92 patients.
  
  
  METHODS
  Thirty-three patients had 36 large aortic and/or peripheral artery aneurysms, 48 had 53 multilevel limb-threatening aortoiliac and/or femoropopliteal occlusive lesions, and 11 had traumatic arterial injuries (false aneurysms and arteriovenous fistulas). Endovascular grafts were placed through remote arteriotomies under local (16[17%]), epidural (42[43%]), or general (38[40%]) anesthesia.
  
  
  RESULTS
  Technical and clinical successes were achieved in 91% of the patients with aneurysms, 91% with occlusive lesions, and 100% with traumatic arterial lesions. These patients and grafts have been followed from 1 to 30 months (mean, 13 months). The primary and secondary patency rates at 18 months for aortoiliac occlusions were 77% and 95%, respectively. The 18-month limb salvage rate was 98%. Immediately after aortic aneurysm exclusion, a total of 6 (33%) perigraft channels were detected; 3 of these closed within 8 weeks. Endovascular stented graft procedures were associated with a 10% major and a 14% minor complication rate. The overall 30-day mortality rate for this entire series was 6%.
  
  
  CONCLUSIONS
  This initial experience with endovascular graft repair of complex arterial lesions justifies further use and careful evaluation of this technique for major arterial reconstruction.
authors.affiliation: Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Marin
authors.forename: F J
authors.initials: FJ
authors.lastname: Veith
authors.forename: J
authors.initials: J
authors.lastname: Cynamon
authors.forename: L A
authors.initials: LA
authors.lastname: Sanchez
authors.forename: R T
authors.initials: RT
authors.lastname: Lyon
authors.forename: B A
authors.initials: BA
authors.lastname: Levine
authors.forename: C W
authors.initials: CW
authors.lastname: Bakal
authors.forename: W D
authors.initials: WD
authors.lastname: Suggs
authors.forename: K R
authors.initials: KR
authors.lastname: Wengerter
authors.forename: S P
authors.initials: SP
authors.lastname: Rivers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D001158:Arteries / Q000293:injuries; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D015607:Stents; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods