Experience with endovascular grafts in the treatment of infrarenal aortic aneurysms associated with proximal aortic dissection.
BACKGROUND
Chronic abdominal and thoracic aortic dissections often present with concomitant infrarenal aortic dilatation. We conducted a retrospective review of 6 patients treated with endovascular stent grafts for coexisting aortic dissection and infrarenal aneurysm.


METHODS
Six patients with suprarenal aortic dissections and infrarenal aortic aneurysms (AAA) had their AAAs treated with endovascular grafts. Grafts were constructed of balloon expandable Palmaz stents and expanded polytetrafluoroethylene graft. The device was inserted transfemorally and deployed under fluoroscopy.


RESULTS
Successfully primary AAA exclusion was achieved in 5 patients. One patient required a supplemental stent placed above the endograft and into the true lumen to seal the endoleak. No aneurysm has enlarged, and all remain thrombosed for 9 to 24 months (mean 20). One type III dissection enlarged 2 weeks after endograft insertion. One patient had uncomplicated cephalad fenestration of a dissection by the endograft.


CONCLUSIONS
Endovascular grafts may be used to treat coexisting AAA and aortic dissection. Attention to the site or sites of reentry of a dissection is essential to insure full aortic aneurysm exclusion. The fate of a chronic aortic dissection cephalad to an endovascularly treated AAA is unclear and will require longer follow-up.
Marin
M L
ML
Department of Surgery, Mount Sinai Medical Center, New York, New York 10029-6574, USA.
Lyon
R T
RT
Hollier
L H
LH
Kaplan
D B
DB
D000784:Aortic Dissection / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D004724:Endoscopy; D005240:Feasibility Studies; D006801:Humans; D012189:Retrospective Studies