Intraoperative proximal endoleaks during AAA stent-graft repair: evaluation of risk factors and treatment with Palmaz stents.
OBJECTIVE
To study factors that might contribute to intraoperative proximal type I endoleak and to evaluate the placement of giant Palmaz stents as a therapeutic option.


METHODS
Thirty-three patients (30 men; median age 72 years, range 50-85) with abdominal aortic aneurysms underwent implantation of fully supported Gianturco Z-stent-based endografts (12 custom-made aortomonoiliac and 21 bifurcated Zenith devices). Ten (30%) patients were treated for intraoperative proximal endoleaks. Stent-graft oversizing and neck angulation, length, and shape were compared between patients with and without leaks.


RESULTS
In 9 cases, the endoleaks were successfully treated with intraoperative placement of Palmaz stents without complications. In 1 patient, a leak that was resolved intraoperatively with balloon dilation reappeared 1 month later; a Palmaz stent was deployed successfully. Stent-graft oversizing did not differ significantly between patients who developed proximal endoleaks and those who did not (median 4.0 mm in both groups, p = 0.47). Median neck length was 21.0 mm in patients with endoleak and 28.0 mm in those without (p > 0.99). Median neck angulation was 30 degrees in both groups (p = 0.33), and the presence of a conical aneurysm neck was not significantly different (2/10 versus 6/23, p > 0.99). All aneurysms remained excluded at a median follow-up of 13 months (range 6-24).


CONCLUSIONS
Stent-graft oversizing and neck morphology (length, angulation, and conical shape) do not seem to correlate with the incidence of proximal type I endoleaks. Palmaz stent placement appears to be a feasible and safe treatment option for this complication.
Dias
N V
NV
Department of Radiology, Malmö University Hospital, Sweden.
Resch
T
T
Malina
M
M
Lindblad
B
B
Ivancev
K
K
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications* / Q000628:therapy*; D002404:Catheterization / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation