Endovascular AAA repair with the aortomonoiliac EndoFit stent-graft: two years' experience.
OBJECTIVE
To evaluate the feasibility and efficacy of a specific aortomonoiliac endograft and the durability of the femorofemoral bypass for treatment of abdominal aortic aneurysm (AAA).


METHODS
From 2002 to 2004, 39 high-risk (ASA III/IV) patients (36 men; median age 74 years, range 63-84) with AAA (n = 33) or AAA and common iliac artery aneurysm (n = 6) were treated with an EndoFit aortomonoiliac endograft and femorofemoral crossover bypass. The contralateral iliac axis was obstructed with an endoluminal occluder. Patients were followed with contrast-enhanced computed tomography at 1, 6, 12, and 24 months.


RESULTS
EndoFit AMI stent-grafts were implanted successfully in all patients. Perioperative mortality was zero. Endoleak occurred in 3 (7.7%) cases. A proximal type I endoleak was identified at 1 month and was treated with a proximal cuff. Two type II endoleaks are under surveillance because the aneurysm sac shows no enlargement. Thrombosis of the femorofemoral graft occurred in 1 case during the immediate postoperative period due to insufficient inflow from a residual stenosis of the endograft (primary patency 97.5%). The deficit was treated successfully (secondary patency 100%). Two (5.1%) tunnel hematomas were treated conventionally. Median follow-up was 14 months (range 6-30). All patients are alive. None of the aneurysms has ruptured or been converted to an open procedure. Graft migration, serious infection, paraplegia, distal embolization, or any other serious complication has not been observed.


CONCLUSIONS
In high surgical risk patients with complex iliac anatomy, aortomonoiliac endograft with femorofemoral crossover bypass is feasible and efficacious. Moreover, the midterm patency of the extra-anatomic bypass appears quite satisfactory.
Saratzis
Nikolaos
N
First Department of Surgery, Aristotle University, Papageorgiou General Hospital, Thessaloniki, Greece. nicos_saratzis@yahoo.com
Melas
Nikolaos
N
Lazaridis
John
J
Ginis
George
G
Antonitsis
Polychronis
P
Lykopoulos
Dimitrios
D
Lioupis
Athanasios
A
Gitas
Christos
C
Kiskinis
Dimitrios
D
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000295:instrumentation; D000792:Angiography; D017546:Angioscopy / Q000379:methods*; D001012:Aorta, Abdominal / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome