title: Custom bifurcated stent-graft for abdominal aortic aneurysms: initial experience.
abstract: OBJECTIVE
  To describe a custom bifurcated stent-graft for possible treatment of abdominal aortic aneurysm (AAA).
  
  
  METHODS
  Five male patients (mean age, 76 +/- 6 years), who had AAA (mean diameter, 4.7 +/- 0.4 cm) and who were considered to be at high risk for conventional surgery, were treated with a custom modular bifurcated stent-graft constructed with bifurcated 24-mm x 12-mm (upper body diameter x iliac limb diameter) Cooley Veri-Soft Woven polyester grafts and Gianturco-Rösch Z stents. The stent-graft body was delivered through 20-22-F sheaths, and the contralateral iliac limb was delivered through a 16-F sheath by means of surgical exposure of the common femoral arteries. A flared distal limb extender (12 mm to 14 mm) was created for one patient to accommodate a large common iliac artery.
  
  
  RESULTS
  Stent-grafts were successfully deployed without complications in all five patients. There were no proximal or distal leaks. A lumbar-to-inferior mesenteric artery leak was seen in one patient at 24 hours. At 6-month follow-up, all devices were intact, with complete exclusion and shrinkage of the aneurysm in four of five patients. Aneurysm size remained stable in the one patient with a lumbar-to-inferior mesenteric artery leak.
  
  
  CONCLUSIONS
  A custom, bifurcated stent-graft was utilized for endovascular treatment of AAA. Long-term follow-up is necessary for the device.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Kaufman
authors.forename: D C
authors.initials: DC
authors.lastname: Brewster
authors.forename: S C
authors.initials: SC
authors.lastname: Geller
authors.forename: C M
authors.initials: CM
authors.lastname: Fan
authors.forename: R P
authors.initials: RP
authors.lastname: Cambria
authors.forename: W A
authors.initials: WA
authors.lastname: Abbott
authors.forename: A C
authors.initials: AC
authors.lastname: Waltman
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D000792:Angiography; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001672:Biocompatible Materials; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D011091:Polyesters; D011474:Prosthesis Design; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; D011091:Polyesters