1/25. Periprosthetic leak and rupture after endovascular repair of abdominal aortic aneurysm: the significance of device design for long-term results.We present a case of abdominal aortic aneurysm treated with an endovascular bifurcated aortic graft in which a periprosthetic leak caused by a tear in the polyester prosthesis appeared between 9 and 12 months after surgery. The tear appeared adjacent to a suture breakage that caused separation of two struts of the nitinol wire framework in the body of the stent graft. The leak was sealed with insertion of a new endovascular tube graft into the body of the bifurcation. Eight months later, the patient had a nonfatal rupture of the abdominal aortic aneurysm because detachment of the second limb from the bifurcation caused a new major periprosthetic leak. According to the manufacturer of this device, suture breakage with separation of metal components is commonly seen, but perforation of the polyester prosthesis caused by movement of the metal stent against the fabric has not been reported. It is likely that this occurred in our patient. Detachment of the second limb from the bifurcated stent, causing a rupture, has been described before. Increasing angulation and tortuosity of the stent graft, as a result of either remodeling of the sac or elongation of the stent, and reduced compliance to angulation after the stent-in-stent procedure might have contributed to the detachment in this case.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
2/25. Asymptomatic rupture of an aortoiliac aneurysm.The rupture of an abdominal aortic aneurysm is one of the most feared complications confronted by cardiovascular surgeons. Such ruptures are usually catastrophic, but in some instances the rupture is posterior and remains sealed. These chronic ruptures may manifest with any of a variety of clinical presentations. This report describes an uncommon presentation of a chronic rupture of an aortoiliac aneurysm in a patient with generalized aneurysmal disease. The rupture presented as an asymptomatic giant pulsatile mass in the patient's abdomen. The mass had developed over a period of several years. The literature is also reviewed.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
3/25. Endovascular repair of abdominal aortic aneurysm using a pararenal fenestrated stent-graft.PURPOSE: To report an unusual case of endovascular abdominal aortic aneurysm (AAA) exclusion in which a fenestrated stent-graft was used to seal a proximal Type I endoleak. methods AND RESULTS: An 84-year-old man with a 6.0-cm AAA underwent an aortomonoiliac aneurysm exclusion procedure that was complicated by a proximal endoleak. Because the patient had no right kidney, an additional stent-graft was designed to cover the right renal artery stump while preserving left renal perfusion through a fenestration in the graft material. This approach was successful in obliterating the endoleak around the proximal attachment site, but flow through the lumbar arteries remained. CONCLUSIONS: The use of a fenestrated stent-graft is feasible, but the type of fenestration in this case has limited applicability owing to the rarity of patients with suitable anatomy.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
4/25. Hybrid open-endoluminal technique for repair of thoracoabdominal aneurysm involving the celiac axis.PURPOSE: To describe a technique combining endoluminal and open approaches for the repair of thoracoabdominal aneurysms involving the celiac axis. CASE REPORT: Two patients with type I thoracoabdominal aneurysm and suboptimal cardiac reserve underwent transluminal stent-graft implantation. To achieve satisfactory distal seal, the caudal end of the endograft was circumscribed with a Dacron band that was sutured to the aorta and endograft through a midline incision. The patent celiac artery in both patients was ligated to stop retrograde filling of the aneurysm sac. The patients developed no problems perioperatively, and exclusion of the aneurysms was confirmed by follow-up imaging. Three years after endografting, both patients had excluded aneurysms without evidence of endoleak or device migration. CONCLUSIONS: This combined approach is another treatment option for thoracic aneurysms that have an anatomically suitable proximal attachment zone with a compromised distal neck.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
5/25. Successful endovascular repair of a leaking abdominal aortic aneurysm under local anesthesia.Local anesthesia is a safe and less invasive anesthetic management for the endovascular approach to elective aortic aneurysm. We have successfully extended the indication of local anesthesia to a high-risk patient with leaking aneurysm and stable hemodynamics. PATIENT AND methods: A 86 year old patient with renal insufficiency due to longstanding hypertension, coronary artery and chronic obstructive lung disease was transferred to our hospital with a leaking abdominal aortic aneurysm. Stable hemodynamics allowed to perform a fast CT scan, that confirmed the feasibility of endovascular repair. A bifurcated endograft (24 mm x 12 mm x 153 mm) was implanted under local anesthesia. RESULTS: The procedure was completed within 85 minutes without problems. The complete sealing of the aneurysm was confirmed by CT scan on the third postoperative day. Twenty months later, the patient is doing well and radiological control confirmed complete exclusion of the aneurysm. DISCUSSION: The endoluminal treatment is a minimally invasive technique. It's feasibility can be rapidly assessed by CT scan. The transfemoral implantation can be performed under local anesthesia provided that hemodynamics are stable. This anesthetic management seems to be particularly advantageous for leaking abdominal aortic aneurysm since it doesn't change the hemodynamic situation in contrast to general anesthesia. Hemodynamic instability, abdominal distension or tenderness may indicate intraperitoneal rupture and conversion to open graft repair should be performed without delay.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
6/25. Aneurysm expansion after stent-graft placement in the absence of endoleak.Sixty-three patients with thoracic or abdominal aortic aneurysms were treated with endovascular stent-grafts. No endoleak was identified at any interval of follow-up in 58 patients. In four of them (7%), the aneurysms expanded by 10 mm or more during follow-up and additional interventions were required. Aneurysm expansion was caused by inappropriate sealing at the aneurysmal necks in two patients and transgraft seroma in the other two. Although some aneurysm expansion could be avoided by proper patient selection and accurate placement of stent-grafts, it seems difficult to predict aneurysm expansion in most cases.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
7/25. rupture of abdominal aortic aneurysm with tear of inferior vena cava in a patient with prior endograft.We report a case of contained rupture of abdominal aortic aneurysm and tear of the inferior vena cava (IVC) 15 months after placement of an aortic endograft (ANEURX graft, Medtronic, Sunnyvale, Calif). A 63-year-old man with significant coronary artery disease underwent endograft exclusion of abdominal aortic aneurysm with Aneurx graft. The patient was seen with a rupture of the aortic aneurysm, probably caused by poor proximal fixation of the graft associated with separation of the left iliac extension limb from the main body of the graft. Angulated right iliac limb of the stent graft penetrated into the Ivc just above the common iliac junction and caused sealed perforation. Successful repair with aortobiiliac graft reconstruction after removal of the endograft was accomplished. The IVC laceration was repaired. Possible mechanisms of failure of endograft are discussed.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
8/25. Infected endovascular graft secondary to coil embolization of endoleak: a demonstration of the importance of operative sterility.A 60-year-old male underwent endovascular repair of a 5.4-cm enlarging abdominal aortic aneurysm with intraoperative recognition of a type I endoleak. The endoleak was demonstrated to be arising from the left limb of the bifurcated prosthesis. An intravascular stent was placed in the limb near the origin of the common iliac artery and it appeared that the endoleak had sealed. However, 1 month after operation a CT scan demonstrated a persistent, substantial size endoleak without aneurysm enlargement. Coil embolization of the endoleak was undertaken in the interventional radiology suite with apparent satisfactory result. Four days after embolization the patient developed abdominal pain and after 8 days fever and leukocytosis developed. Two weeks after embolization an abdominal CT and indium scan revealed an infected endovascular graft. By CT, the posterior wall of the aneurysm was destroyed and a peri-graft fluid collection with gas was present at the location of the coils. The patient was treated with graft and coil excision and autologous vein reconstruction. Endoluminal prostheses can be contaminated at the time of operative placement. However, an additional source of endoluminal graft infection can arise from secondary endovascular procedures for endoleaks and other graft complications. Since we began placing endovascular grafts at our institution in 1993, most coil embolizations have been performed in the interventional radiology suite. This experience of coil-induced infection causes us to consider performing this type of secondary intervention in the operating room environment.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
9/25. Endovascular treatment and complete regression of an infected abdominal aortic aneurysm.PURPOSE: To report a case of successful endovascular treatment of an infected abdominal aortic aneurysm (AAA) following Salmonella septicemia. CASE REPORT: A 60-year-old man was admitted for rapid onset of urinary frequency, fever, and suprapubic pain extending to the flanks. blood cultures were positive for salmonella enteritidis, and appropriate antibiotic treatment was started. After 4 weeks, fever ceased and the c-reactive protein fell to 5.8 mg/dL, but the erythrocyte sedimentation rate remained unchanged. back pain prompted computed tomography, which showed a large AAA with a very irregular aortic wall suspicious of impending rupture. A tube stent-graft was introduced under general anesthesia from a left groin incision and deployed immediately below the renal arteries; a proximal type I endoleak was suspected but not repaired. Oral antibiotic therapy was continued for 2 months after discharge. By 6 months, the endoleak had sealed with a concomitant decrease in the maximal diameter of the aneurysm from 7.4 to 5.6 cm. At 4 years, the aneurysm sac was no longer visible. CONCLUSIONS: Although experience is limited, endovascular grafting in combination with antibiotic therapy in selected infected aneurysms might represent an effective low-risk alternative to conventional surgery with the potential to restore normal vascular anatomy.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
10/25. Side-branched modular endograft system for thoracoabdominal aortic aneurysm repair.PURPOSE: To describe a side-branched modular endograft system that provides adequate visceral artery perfusion with perfect seal during thoracoabdominal aortic aneurysm (TAAA) repair. CASE REPORT: A 76-year-old man with a 57-mm TAAA involving the celiac artery was treated with a customized Talent endograft consisting of a 46-mm x 18-cm stented main body and a 6-mm x 30-mm nonstented Dacron side branch. The graft was delivered through a surgical exposure of the left common femoral artery. A 6-mm x 10-cm Hemobahn stent-graft was introduced in the 30-mm side branch from the aorta to the celiac trunk through a long 8-F sheath via the left brachial artery. The patient recovered uneventfully except for a mild reactive inflammatory syndrome. Postoperative computed tomography demonstrated total exclusion of the TAAA sac and good antegrade perfusion of the celiac and superior mesenteric arteries, which has been maintained at the 6-month follow-up. CONCLUSIONS: Endovascular treatment of TAAA is feasible with further technical refinements of available technology.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
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