Peripheral Vascular Surgery Society
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Peripheral Vascular Surgery Society |
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Program for 1998 Spring Meeting |
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#1 BIFURCATED ENDOVASCULAR GRAFTING FOR AORTIC ANEURYSM (AAA)
David H. Deaton, MD, William M. Bogey, MD, Karl Chiang, MD,
Denise Brigham, BSN, and C. Steven Powell, MD.
East Carolina University
Greenville, NC
Introduction: Endovascular grafting represents a minimally invasive transfemoral technique for prosthetic graft replacement of the aorta in the treatment of AAA. We reviewed our initial experience with an endovascular graft that shares with conventional grafts the characteristics of discrete transaortic fixation and unitary unsupported woven polyester construction.
Methods: Twenty-eight patients (26 male, 2 female; age: 58-93) with infrarenal aortic aneurysms between 41 and 82 millimeters in greatest diameter (x = 55.4 mm) underwent bifurcated endovascular grafting (Guidant/EVT, Menlo Park, CA) over an eighteen month period. Anesthesia risk group classification was: Class II-1, Class III-10, and Class IV-17. All procedures were performed under an FDA Phase II clinical trial protocol with IRB approval. Provisions for immediate conversion to open surgery were made in all cases.
Results: Technical success was achieved in 27/28 cases (96%). There were no acute conversions. Attachment site competence was 97.5% (79/81 sites). Leaks in one proximal and a single iliac attachment site were sealed with a secondary endovascular intervention. No late attachment site leaks occurred. Perigraft flow from aneurysm tributaries was demonstrated in 9 (32%) patients. Tributary based perigraft flow was not treated and no aneurysm with this finding enlarged. There were no graft occlusions acutely or during follow-up. Six grafts received iliac limb support with a WallstentÒ (Schneider, Minneapolis, MN) acutely (n=3) or during follow-up (n=3). Postoperative discharge averaged 2 days (range: 1-5) and one patient had a single night stay in ICU. No patients suffered stroke, myocardial infarction, lower extremity ischemia, renal dysfunction, or other major morbidity prior to discharge. Minor complications occurred in 10 patients. One patient died from pneumonia at 9 months. All other patients are alive at 1-16 months without evidence of graft migration, aneurysm growth, graft occlusion, h