RESULTS AND COMPLICATIONS AFTER ENDOVASCU LAR RECONSTRUCTION OF AORTIC-ANEURYSM

Between August 1994 and December 1936 137 patients (10 female and 127 male, mean age 66 Srs., range 27-85) with aortoiliac aneurysmal diseas e ere treated with endovascular stentgrafts. Pathology included 5 thor acic, 131 abdominal and I isolated iliac artery aneurysm. 88 straight tubegrafts (75 Mintec, 12 EVT, I Chuter) and 43 bifurcated grafts (21 Mintec, 20 EVT, 2 Chuter) were implanted in the infrarenal aorta. 5 (M intec) tubegrafts were used for the thoracic aneurysms. One tapered tu begraft was used to exclude the isolated iliac aneurysm. 11 patients ( 8%) required conversion to open surgical repair. This was due to defec tive dei ices in 5, device related occlusion of a renal artery in 2, a ortic dissection in 1, occlusion of iliac outflow in 1, a large unmana geable proximal endoleak in 1 and a retroperitoneal bleeding resulting in hemorrhagic shock in 1 patient. There was one procedure related de ath for a mortality of 0.7%. Patients were follow ed every 3-6 months using CT with i.v contrast and ultrasound duplex examinations with adj unctive usage of an intravenous ultrasound contrast agent (Levovist(R) , Schering AG). Intraarterial DSA was used only when called for by thr ombotic or stenotic complications. At a mean follow-up of 9,2 months ( range 2-24 months) 16 (17%) primary and 8 (8.5%) secondary leaks (at t he distal anchoring zone) ere detected after implantation of tubegraft s. 11 (25.6%) leaks were detected after implantation of bifurcated gra fts. Iliac artery occlusion was observed in :! patients after placemen t of a straight endograft, 6 times after reconstruction with a il Mint ec bifurcated device and 3 times after implantation of an EVT bifurcat ed endograft. Successful treatment of iliac artery occlusion without t he need for subsequent amputation or major disability included extraan atomic bg pass in 7 patients, PTA (3 patients) and implantation of wal lstents (2 patients) or conservative management (1 patient).