Use of a self-expanding vascular occluder for embolization during endovascular aortic aneurysm repair.
OBJECTIVE
Repair of aortic aneurysms with use of stent-graft techniques may require occlusion of large branch vessels to prevent back-bleeding into the excluded aneurysmal sac. The authors describe their experience using a self-expanding vascular occluder (SEVO) to occlude flow in branch arteries during aortic stent-grafting.


METHODS
Eighty-four patients (65 men, 19 women; mean age, 64 years) underwent thoracic (n = 72) or abdominal aortic (n = 12) stent-grafting. Aneurysm repair was performed using nonbifurcated Z stents covered with polyester or polytetrafluoroethylene (PTFE) fabric. SEVOs constructed from a Z stent (10-20 mm diameter) and PTFE were deployed through a separate catheter (14-20 F).


RESULTS
Ten of 84 patients required embolization of large branch arteries with use of a SEVO during aortic stent-grafting (thoracic, n = 1; abdominal, n = 9). The SEVO was placed in the common iliac (n = 9) or subclavian artery (n = 1). The mean SEVO diameter was 14.7 mm (range, 10-20 mm). Eight patients undergoing SEVO embolization had immediate thrombosis of the treated artery. One patient required additional embolization with use of conventional coils. No patients had back-bleeding into the aneurysm, device migration, microembolization, or limb ischemia (mean follow-up, 140 days; range, 50-200). All 10 patients had complete thrombosis of the aortic aneurysm.


CONCLUSIONS
Use of a novel self-expanding vascular occluding device is a safe and effective supplementary technique to occlude high-flow, large-diameter arterial branch vessels during endovascular aortic aneurysm repair.
Kato
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Division of Cardiovascular-International Radiology, Stanford University Medical Center, CA 94305-5105, USA.
Semba
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CP
Dake
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MD
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000628:therapy*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000628:therapy*; D001027:Aortography; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015607:Stents; D016896:Treatment Outcome