Long-term results of endovascular AAA repair using a homemade aortomonoiliac PTFE device.
OBJECTIVE
To assess the long-term results of a homemade aortomonoiliac polytetrafluoroethylene (PTFE) device used for endovascular abdominal aortic aneurysm (AAA) repair.


METHODS
A vascular audit database was interrogated to identify 58 consecutive AAA patients (all men; median age 73 years, range 56-88) who underwent aortomonoiliac stent-graft repair. AAAs were eligible for endovascular treatment if the infrarenal neck was > or = 15 mm long and < or = 28 mm in diameter.


RESULTS
Nine (15.5%) procedures failed, 8 during the procedure and 1 on the 7th postoperative day; 8(13.8%) patients were converted, but one was unfit for surgery. There was one intraprocedural stroke, and 3 (5.2%) patients died within 30 days. The primary success rate (no conversion or mortality) was 79.3%. Over a median follow-up of 45 months (range 23-80), there were 3 (5.2%) graft occlusions, 1 kink requiring stent implantation, and 1 expanding sac without identifiable endoleak. There were 11 (19.0%) endoleaks in 10 patients, 9 type I leaks (2 proximal) and 1 type II. One patient with a distal type I endoleak (treated) also exhibited a type III leak at 2 years, but the sac size had not increased. There was a 40% incidence of bilateral buttock claudication, which was serious in only 1 patient. The long-term survival rate by Kaplan-Meier life-table analysis was 57% at 4 years.


CONCLUSIONS
Implantation of an aortomonoiliac PTFE device can be achieved with good primary success, and the stent-graft seems durable over the long term. Proximal type I endoleaks are rare, but distal endoleaks from the contralateral common iliac artery can be solved by using a different covered stent.
Ingle
Hemant
H
Department of Vascular Surgery and Radiology, Leicester Royal Infirmary, Leicester, England, UK. h_ingle@hotmail.com
Fishwick
Guy
G
Garnham
Andrew
A
Thompson
Matthew M
MM
Bell
Peter R F
PR
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D011474:Prosthesis Design; D015607:Stents; D016896:Treatment Outcome
D011138:Polytetrafluoroethylene