Aortomonoiliac stent-grafts for abdominal aortic aneurysm repair: association with iliofemoral crossover grafts.
OBJECTIVE
To analyze the outcome of endovascular exclusion of abdominal aortic aneurysm (AAA) using aortomonoiliac stent-grafts.


METHODS
Fifty-seven consecutive patients (49 men; median age 70, range 56-89) with AAA >5 cm were treated in a 6-year period with the conical ELLA stent-graft. Forty-two (73.9%) patients were classified ASA (American Society of Anesthesiologists) IV and 6 as ASA V. In the majority of cases, the implantation procedure featured device delivery through the external iliac artery, transrenal placement of a bare stent in selected cases, and an iliofemoral crossover graft through a prevesical tunnel.


RESULTS
Successful deployment was achieved in 56 (98.2%) patients. Mean time to discharge was 8.7 days (range 2-125). Two patients died in the 30-day period. Nine endoleaks occurred in 8 (14%) patients; 4 required further intervention. Mean follow-up was 35.3 months (range 1-66), during which 5 patients died from unrelated causes. No late endoleak, graft occlusion, device twisting/migration, or aneurysm rupture was observed. No correlation between type I endoleaks and unfavorable proximal neck or iliac artery anatomical characteristics could be found. Primary technical and clinical success rates were 86.0% and 94.7%, respectively.


CONCLUSIONS
In this approach, the crossover graft remains in a retropubic space and consequently does not have all the disadvantages of a subcutaneously placed prosthesis. The results achieved in this group of high-risk patients support recommendation of this technique as a simple and safe alternative to bifurcated systems.
Pereira
Adamastor Humberto
AH
Department of Vascular Surgery, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul. epereira@terra.com.br
Sanvitto
Paulo Cesar
PC
de Souza
Gilberto Gonçalves
GG
Costa
Luiz Francisco
LF
Grudtner
Marco Aurélio
MA
D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000401:mortality / Q000601:surgery*; D001011:Aorta / Q000637:transplantation*; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D020878:Device Removal; D005260:Female; D005263:Femoral Artery / Q000293:injuries / Q000637:transplantation; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000293:injuries / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D011474:Prosthesis Design; D012086:Reoperation; D012720:Severity of Illness Index; D015607:Stents; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex