Occluding aortic endoluminal stent graft combined with extra-anatomic axillofemoral bypass as alternative management of abdominal aortic aneurysms for patients at high risk with complex anatomic features: a preliminary report.
OBJECTIVE
To describe an exclusion endoluminal technique for management of abdominal aortic aneurysms among high-risk patients with complex anatomic features.


METHODS
From January 1995 to December 1996, among 143 patients with infrarenal abdominal aortic aneurysm treated by means of endograft placement, 9 (6.3%) had complex aortic or aortoiliac morphologic features. For these patients, the endograft was delivered through a femoral cutdown in an occluding aortoiliac configuration. The contralateral iliac artery was occluded with an iliac endograft. Axillofemoral bypass grafting was performed. Computed tomographic scans were obtained regularly.


RESULTS
There was 1 postoperative death of severe arrhythmia. All aneurysms were found to be affected by thrombosis on immediately postoperative computed tomographic scans, except in 1 patient with a proximal leak, which was managed successfully with angiographic embolization. The mean follow-up time was 12 months. Aortic aneurysm diameter decreased from 2 mm at 6 months (2 patients) to 6 mm at 12 months (6 patients). All axillofemoral bypass grafts are patent.


CONCLUSIONS
Placement of an occluding endograft associated with axillofemoral bypass grafting is a good alternative for patients at high risk with complex anatomic features. Longer-term follow-up study is needed to evaluate this endoluminal technique.
Le Minh
T
T
Department of Vascular Pathology, Erasme Hospital, University Clinics of Brussels, Belgium.
Motte
S
S
Hoang
A D
AD
Ferreira
J
J
Golzarian
J
J
Dehon
P
P
Cavenaile
J C
JC
Michel
P
P
Guyot
S
S
Giot
C
C
Wautrecht
J C
JC
Dereume
J P
JP
D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000473:pathology; D017544:Aortic Aneurysm, Abdominal / Q000473:pathology / Q000601:surgery*; D001366:Axillary Artery / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007083:Iliac Artery / Q000473:pathology; D008297:Male; D015607:Stents; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*