title: Intraoperative proximal endoleaks during AAA stent-graft repair: evaluation of risk factors and treatment with Palmaz stents.
abstract: 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.
authors.affiliation: Department of Radiology, Malmö University Hospital, Sweden.
authors.forename: N V
authors.initials: NV
authors.lastname: Dias
authors.forename: T
authors.initials: T
authors.lastname: Resch
authors.forename: M
authors.initials: M
authors.lastname: Malina
authors.forename: B
authors.initials: B
authors.lastname: Lindblad
authors.forename: K
authors.initials: K
authors.lastname: Ivancev
mesh_terms: 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