Peripheral Vascular Surgery Society

Materials and Methods: From January 1996 to March 1997, 71 aorto-iliac aneurysms were treated using stent-grafts made to measure with Z auto-expandable stainless steel stents compiled with polyester sutures and covered with commercially available Dacron vascular prostheses. These stent-grafts were implanted through 18 to 24 (typically 20) Fr. commercially available introducers via a surgical remote access. The making-to-measure of tubular, bifurcated, tapered and/or blind combined with extra-anatomic bypass designs enhanced the share of endovascular treatment in our experience. This share was further enhanced with the use of uncovered proximal or distal stents whenever dealing with short or tortuous necks near from major collaterals and with the use of hybrid, partly surgical designs, with one stented and the other stentless ends, the lesser allowing for a surgically-made anastomosis.

Results: Using these techniques, we achieved a high feasibility of the endovascular treatment of aorto-iliac aneurysms since among the 28 cures of unselected infra-renal cases referred to us from January to March 1998, 22 (78.6%) were endovascular. Our results display a typical learning curve pattern since from January 1996 to June 1997, only 14 endovascular cures were attempted among 160 cases with only 7 good results, 3 conversions, 3 major complications and 1 endoleak. From July 1997 to March 1998, 48 (63.1%) endovascular cures were attempted among the 76 unselected infra-renal cases referred to us. A myocardial infarction at D4 accounted for one death in a high-risk patient. There were 2 endoleaks and one thrombosis of the graft, while a good result was achieved in all other (91.7%) patients. During the same later period, these techniques allowed us for the treatment of 9 aneurysms of the thoracic aorta with one conversion, one death in a high risk patient and a good result in all other cases.

Conclusion: The making to measure of stent-grafts greatly enhances the feasibility and the efficiency of endovascular treatment of aorto-iliac aneurysms.