An assessment of the current applicability of the EVT endovascular graft for treatment of patients with an infrarenal abdominal aortic aneurysm

被引:54
作者
Treiman, GS
Lawrence, PF
Edwards, WH
Galt, SW
Kraiss, LW
Bhirangi, K
机构
[1] Univ Utah, Sch Med, Div Vasc Surg, Salt Lake City, UT 84132 USA
[2] St Thomas Hosp, Dept Surg, Nashville, TN USA
[3] Vanderbilt Univ, Med Ctr, Div Vasc Surg, Sect Surg Sci, Nashville, TN USA
关键词
D O I
10.1016/S0741-5214(99)70177-1
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: To determine the percentage of elective abdominal aortic aneurysms (AAAs)/aortoiliac aneurysms that currently can be repaired with endovascular grafts (EVGs), the reasons for rejection of EVGs, and the future role of EVG in the treatment of AAA. Methods: From January 1997 to May 1998, patients at three hospitals (a university hospital, a university-affiliated teaching hospital, and a Veterans Administration hospital with university faculty and residents) were evaluated for EVGs as part of a national clinical trial with grafts manufactured by Endovascular Technologies (EVT, Menlo Park, Calif). All patients at two hospitals and patients treated by the participating surgeons at the third hospital were screened for EVG. Patients with AAAs that were ruptured, symptomatic, or involved renal or mesenteric arteries and patients who declined treatment were excluded from the study. Evaluation included clinical examination, computed tomography scan, and selective arteriography. The decision to proceed with EVG was made by the vascular surgeon, with input and concurrence of medical personnel from a company with extensive experience in endograft repair. The main outcome measures were the determination of the percentage of elective AAAs currently being treated with an EVG and the reasons for exclusion of patients from EVG placement. Results: A total of 162 patients underwent elective treatment of an AAA, 22 (14%) with an EVG (14 bifurcated, eight tube) and 140 (86%) with traditional resection. Indications for not proceeding with an EVG included insufficient proximal cuff in 29 patients (21%), distal common iliac aneurysm or insufficient distal iliac neck in 29 patients (21%), proximal neck too large for an EVG in 24 patients (17%), symptomatic iliac stenosis in 23 patients (16%), iliac stenosis precluding introducer passage in 17 patients (12%), patient preference in 11 patients (8%), and calcification, kink, or extensive thrombus involving the proximal neck precluding safe graft attachment in seven patients (5%). Of the 22 patients treated with an EVG, three were converted to open resection, because of iliac stenosis in two patients and premature stent deployment in one patient (initial technical success rate, 86%). Conclusion: Based on currently available technology, 80% of patients were not candidates for an EVG because of proximal calcification, short aortic or distal cuff, coexisting distal iliac aneurysm, and stenotic iliac disease. Even with the use of adjunctive procedures, most patients still require open repair. Significant changes in design will be necessary to apply these de-vices to most patients with an AAA.
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页码:68 / 74
页数:7
相关论文
共 30 条
  • [1] Anatomical suitability of abdominal aortic aneurysms for endovascular repair
    Armon, MP
    Yusuf, SW
    Latief, K
    Whitaker, SC
    Gregson, RHS
    Wenham, PW
    Hopkinson, BR
    [J]. BRITISH JOURNAL OF SURGERY, 1997, 84 (02) : 178 - 180
  • [2] Computed tomographic angiographic imaging of abdominal aortic aneurysms: Implications for transfemoral endovascular aneurysm management
    Balm, R
    Stokking, R
    Kaatee, R
    Blankensteijn, JD
    Eikelboom, BC
    vanLeeuwen, MS
    [J]. JOURNAL OF VASCULAR SURGERY, 1997, 26 (02) : 231 - 237
  • [3] Morphologic assessment of abdominal aortic aneurysms by spiral computed tomographic scanning
    Bayle, O
    Branchereau, A
    Rosset, E
    Guillemot, E
    Beaurain, P
    Ferdani, M
    Jausseran, JM
    [J]. JOURNAL OF VASCULAR SURGERY, 1997, 26 (02) : 238 - 246
  • [4] Endoluminal stent-grafts for infrarenal abdominal aortic aneurysms
    Blum, U
    Voshage, G
    Lammer, J
    Beyersdorf, F
    Tollner, D
    Kretschmer, G
    Spillner, G
    Polterauer, P
    Nagel, G
    Holzenbein, T
    Thurnher, S
    Langer, M
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1997, 336 (01) : 13 - 20
  • [5] Abdominal aortic aneurysms: Preliminary technical and clinical results with transfemoral placement of endovascular self-expanding stent-grafts
    Blum, U
    Langer, M
    Spillner, G
    Mialhe, C
    Beyersdorf, F
    BuitragoTellez, C
    Voshage, G
    Duber, C
    Schlosser, V
    Cragg, AH
    [J]. RADIOLOGY, 1996, 198 (01) : 25 - 31
  • [6] Initial experience with endovascular aneurysm repair: Comparison of early results with outcome of conventional open repair
    Brewster, DC
    Geller, SC
    Kaufman, JA
    Cambria, RP
    Gertler, JP
    LaMuraglia, GM
    Atamian, S
    Abbott, WM
    [J]. JOURNAL OF VASCULAR SURGERY, 1998, 27 (06) : 992 - 1003
  • [7] INFRARENAL AORTIC-ANEURYSM STRUCTURE - IMPLICATIONS FOR TRANSFEMORAL REPAIR
    CHUTER, TAM
    GREEN, RM
    OURIEL, K
    DEWEESE, JA
    [J]. JOURNAL OF VASCULAR SURGERY, 1994, 20 (01) : 44 - 50
  • [8] JUXTARENAL INFRARENAL ABDOMINAL AORTIC-ANEURYSM - SPECIAL DIAGNOSTIC AND THERAPEUTIC CONSIDERATIONS
    CRAWFORD, ES
    BECKETT, WC
    GREER, MS
    [J]. ANNALS OF SURGERY, 1986, 203 (06) : 661 - 670
  • [9] Treatment of abdominal aortic aneurysms with transfemoral placement of stent-grafts: Complications and secondary radiologic intervention
    Dorffner, R
    Thurnher, S
    Polterauer, P
    Kretschmer, G
    Lammer, J
    [J]. RADIOLOGY, 1997, 204 (01) : 79 - 86
  • [10] Edwards WH, 1996, ANN SURG, V223, P568, DOI 10.1097/00000658-199605000-00012