Coupling bifurcated stent-grafts to overcome anatomic limitations of endovascular repair of abdominal aortic aneurysms.
OBJECTIVE
To evaluate the effectiveness of the coupling stent-graft technique and outcomes on contrast-enhanced computed tomography (CT).


METHODS
All patients who underwent endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) between 2007 and 2010 at a single institution were retrospectively analyzed. Of the 161 cases, 19 patients who had coupling stent-grafting because of AAA proximal neck angulation greater than 60°, conical neck, or iliac tortuosity were included. Patient age ranged from 62 to 87 years (mean, 73.3 y). Mean follow-up was 18.7 months (range, 1-36 mo). The coupling stent-graft technique was defined by the use of suprarenal fixation device main bodies (Zenith or Talent) with one or more EXCLUDER limbs to adapt tortuous and angulated iliac arteries. Pretreatment contrast-enhanced CT was analyzed based on three-dimensional and multiplanar reformatted images. Follow-up contrast-enhanced CT was also analyzed.


RESULTS
Mean aneurysm diameter was 68.9 mm ± 14.0, neck length was 32.7 mm ± 15.1, and neck angulation was 68.9° ± 11.5. Conical neck shapes were present in four patients (21.1%) and ruptured AAAs were present in two (10.5%). Among 38 iliac arteries, the mean iliac artery tortuosity index was 1.52 ± 0.27 and iliac angle was 106.8° ± 18.1. Three patients (15.8%) underwent repeat intervention: placement of a balloon-expandable stent in the proximal neck for type I endoleak (n = 1), endovascular embolization for proximal type I endoleak (n = 1), and percutaneous approach following endovascular embolization for type II endoleak (n = 1). No type III endoleak, limb occlusion, limb kinking, or stent-graft migration developed.


CONCLUSIONS
The coupling stent-graft technique is technically feasible, with acceptable midterm outcomes in EVAR of AAA in patients with unfavorable neck and iliac anatomies.
Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul, Republic of Korea.
Myungsu
M
Lee
Do Yun
DY
Lee
Man Deuk
MD
Kim
Kwang-Hun
KH
Lee
Mu Sook
MS
Lee
Sung Il
SI
Park
Jong Yun
JY
Won
Donghoon
D
Choi
Young-Guk
YG
Ko
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D003287:Contrast Media; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011857:Radiographic Image Interpretation, Computer-Assisted; D056910:Republic of Korea; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D003287:Contrast Media