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27.5 Aortic aneurysm treatment with endoluminal prosthesis under local anaesthesia
with aorto-iliac fixation showed expansion of the sac at 15 months due to pet&aft flow and was converted to open operation, and a fourth patient with aorto-aortic fixation developed graft infection requiring removal of the stent-graft at 9 months. The problems for AAA exclusion were mismatch of the stent-graft to the aortic lumen resulting in endoleak. All four popliteal aneurysms, the single ilio-iliac and the remaining nine aortic aneurysms remain well, free of endoleak and with stable or diminishing sac size at l-18 months. Conclusions: It is vital to obtain accurate estimates of AAA neck size and shape to avoid the complication of endoleak, and to allow successful deployment when good results may be anticipated in the medium term. The technique is versatile and allows exclusion of AAA, iliac and popliteal aneurysms and may prove cheaper than currently marketed devices, and can be tailored to suit the measurements of the patient’s AAA.
27.5 Aortic Aneurysm Treatment with Endoluminal ProsthesisUnder Local Anaesthesia H.E. ZEPLIN, H. SIEVERT, R. SCHRADER and H.E SPIES, Frankfurt, Germany The interventional transluminal implantation of endovascular prostheses is the treatment of choice in patients with multiple risk factors jeopardising surgical aneurysm repair. The procedure is usually performed under general anaesthesia in the operation theatre with suboptional X-ray equipment. Patients and methods: From 1995 to December 1996 a team of cardiologists and vascular surgeons treated nine patients with an endoluminal aortic prosthesis. All patients had multiple risk factors as abdominal operations, open heart operations, obesity and others. In the cath lab under local anaesthesia the right common femoral artery was opened surgically, the graft was introduced, the left leg of the bifurcation prosthesis was implanted transcutaneously via the left femoral artery. Age of patients: 72.3 (63-83) years, diameter of aneurysm 4.4 (3.8-6.0) cm, longitude 8.2 (6.0-13) cm. The operation time was 80 (63-145) min, X-ray-time 20 (15-38)min, account of contrast dye was 112 ml (range 70-320 ml). In a clinical observation time of 5 days postoperatively no complication occurred, especially no systemic coagulation or inflammatory disorders were observed Laboratory investigations revealed a decrease of haemoglobin levels due to the intraoperative blood loss only. The follow-up period was up to 12 months, control angiograms and CT documented total exclusion of the aneurysm in all cases. Conclusion: The transcutaneous implantation of a transluminal bifurcation prosthesis for the treatment of aortic aneurysms is feasible in local anaesthesia in patients with multiple risk factors for surgery and general anaesthesia.
CARDIOVASCULAR SURGERY SEPTEMBER 1997
27.6 Utility of Intravascular I&~~MxBu&in Abbminal Aortic Aneurysm En&graft C.E. DONAYRE, R.A. WHITE, EM. If USSAIN, D.C. BURKLUND, G.E. KOPCHOK, C. DE VIRGILIO,.M. HEILBRONJk aHd I. WALOT, Torrance, California, USA Purpose: Computerized tomography (CT) and angiography are currently used in the selection, treatment and follow-up of patients with abdominal aortic aneurysm (AAA) endografts. This study assessed the impact of intravascular ultrasound (IVUS) on outcome when it is used to aid device selection and deployment. Methods: Thirty-three patients (mean age 72 years) with AAAs (mean diameter 58mm) were treated utilizing 13 balloon expandable (one tube, nine aorto-uniiliac), and 20 self-expanding devices (one tube, 19 bifurcated). MIS and CT were employed to measure the dimensions of the aortic and iliac vessels, to determine the length from the renal artery to the origin of the hypogastric arteries, to assess vessel morphology and choose deployment sites. IVUS was also used to guide full stent apposition to the arterial wall after device placement. Final device selection was based on IVUS data, if there was a disparity between imaging methods. Results: For the self-expanding bifurcated devices, the diameters of the proximal aortic necks were statistically equivalent using CT and IVUS (21.8mm +/-3.4 versus 21.5 m m +/-2.9, P = 0.3), but if CT measurements were used to select the endoprosthesis, three patients (16%) would have received a device smaller than the internal diameter measured by IVUS, possibly potentiating the formation of an endoleak. IVUS measurements were smaller than CT at the distal iliac deployment site (left 12.7mm +/-2.6 versus 14.3 m m +/--3.7; right 12.7 m m +/-2.7 versus 14.0 m m +/-2.9, P = 0.05]. Renal to hypogastric lengths measured by IVUS were longer than by CT (171.7mm +/- 19.2 versus 154mm +/- 10.7, P = 0.2). At an average 8 month follow-up (1 to 22), only one endoleak developed (3%) and one of 44 iliac limbs thrombosed (2%); both occurring at sites assessed only by cinefluoroscopy on final inspection. Conclusion: The use of CT and IVUS in the selection and assessment of endografts post-deployment appears to lower the endoleak and thrombosis rates probably related to more accurate determination of arterial wall dimensions and transmural morphology.
27.7 Economic Impact of Endovasculat Grafts for the Treatment of Iliac Arterv Aneurvsms L.A. SANCHEZ, M .L. ~LIARIN; EJ. VEITH, WD. SUGGS and R.T. LYON, New York, New York, USA. Endovascular arterial grafting (EG) has been described as a less invasive technique with the potential for decreased morbidity and mortality, resulting in a reduction in the use of hospital resources. These grafts have been used for the treatment of aneurysmal, occlusive, and traumatic arterial lesions with favorable early success but their long-term functional and economic impact has not been fully evaluated.
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27.5 Aortic Aneurysm Treatment with Endoluminal ProsthesisUnder Local Anaesthesia H.E. ZEPLIN, H. SIEVERT, R. SCHRADER and H.E SPIES, Frankfurt, Germany The interventional transluminal implantation of endovascular prostheses is the treatment of choice in patients with multiple risk factors jeopardising surgical aneurysm repair. The procedure is usually performed under general anaesthesia in the operation theatre with suboptional X-ray equipment. Patients and methods: From 1995 to December 1996 a team of cardiologists and vascular surgeons treated nine patients with an endoluminal aortic prosthesis. All patients had multiple risk factors as abdominal operations, open heart operations, obesity and others. In the cath lab under local anaesthesia the right common femoral artery was opened surgically, the graft was introduced, the left leg of the bifurcation prosthesis was implanted transcutaneously via the left femoral artery. Age of patients: 72.3 (63-83) years, diameter of aneurysm 4.4 (3.8-6.0) cm, longitude 8.2 (6.0-13) cm. The operation time was 80 (63-145) min, X-ray-time 20 (15-38)min, account of contrast dye was 112 ml (range 70-320 ml). In a clinical observation time of 5 days postoperatively no complication occurred, especially no systemic coagulation or inflammatory disorders were observed Laboratory investigations revealed a decrease of haemoglobin levels due to the intraoperative blood loss only. The follow-up period was up to 12 months, control angiograms and CT documented total exclusion of the aneurysm in all cases. Conclusion: The transcutaneous implantation of a transluminal bifurcation prosthesis for the treatment of aortic aneurysms is feasible in local anaesthesia in patients with multiple risk factors for surgery and general anaesthesia.
CARDIOVASCULAR SURGERY SEPTEMBER 1997
27.6 Utility of Intravascular I&~~MxBu&in Abbminal Aortic Aneurysm En&graft C.E. DONAYRE, R.A. WHITE, EM. If USSAIN, D.C. BURKLUND, G.E. KOPCHOK, C. DE VIRGILIO,.M. HEILBRONJk aHd I. WALOT, Torrance, California, USA Purpose: Computerized tomography (CT) and angiography are currently used in the selection, treatment and follow-up of patients with abdominal aortic aneurysm (AAA) endografts. This study assessed the impact of intravascular ultrasound (IVUS) on outcome when it is used to aid device selection and deployment. Methods: Thirty-three patients (mean age 72 years) with AAAs (mean diameter 58mm) were treated utilizing 13 balloon expandable (one tube, nine aorto-uniiliac), and 20 self-expanding devices (one tube, 19 bifurcated). MIS and CT were employed to measure the dimensions of the aortic and iliac vessels, to determine the length from the renal artery to the origin of the hypogastric arteries, to assess vessel morphology and choose deployment sites. IVUS was also used to guide full stent apposition to the arterial wall after device placement. Final device selection was based on IVUS data, if there was a disparity between imaging methods. Results: For the self-expanding bifurcated devices, the diameters of the proximal aortic necks were statistically equivalent using CT and IVUS (21.8mm +/-3.4 versus 21.5 m m +/-2.9, P = 0.3), but if CT measurements were used to select the endoprosthesis, three patients (16%) would have received a device smaller than the internal diameter measured by IVUS, possibly potentiating the formation of an endoleak. IVUS measurements were smaller than CT at the distal iliac deployment site (left 12.7mm +/-2.6 versus 14.3 m m +/--3.7; right 12.7 m m +/-2.7 versus 14.0 m m +/-2.9, P = 0.05]. Renal to hypogastric lengths measured by IVUS were longer than by CT (171.7mm +/- 19.2 versus 154mm +/- 10.7, P = 0.2). At an average 8 month follow-up (1 to 22), only one endoleak developed (3%) and one of 44 iliac limbs thrombosed (2%); both occurring at sites assessed only by cinefluoroscopy on final inspection. Conclusion: The use of CT and IVUS in the selection and assessment of endografts post-deployment appears to lower the endoleak and thrombosis rates probably related to more accurate determination of arterial wall dimensions and transmural morphology.
27.7 Economic Impact of Endovasculat Grafts for the Treatment of Iliac Arterv Aneurvsms L.A. SANCHEZ, M .L. ~LIARIN; EJ. VEITH, WD. SUGGS and R.T. LYON, New York, New York, USA. Endovascular arterial grafting (EG) has been described as a less invasive technique with the potential for decreased morbidity and mortality, resulting in a reduction in the use of hospital resources. These grafts have been used for the treatment of aneurysmal, occlusive, and traumatic arterial lesions with favorable early success but their long-term functional and economic impact has not been fully evaluated.
137