DEPLOYMENT TECHNIQUE AND HISTOPATHOLOGICAL EVALUATION OF AN ENDOLUMINAL VASCULAR PROSTHESIS USED TO REPAIR AN ILIAC ARTERY ANEURYSM

Purpose:To describe the deployment technique function, and gross heali ng of an endoluminal vascular prosthesis deployed in a high-risk patie nt for treatment of a common iliac artery (CIA) aneurysm. Methods: An 82-year-old, high-risk male with a Gem-diameter CIA aneurysm approxima tely 4.5 to 5 cm long was treated with endoluminal exclusion of the le sion using a 6-cm-long, 14-mm-internal diameter Dacron vascular prosth esis with Palmaz 308 stents sutured to either end of the graft. Intrav ascular ultrasound (IVUS) imaging facilitated sizing of the endograft and its accurate positioning so as to occlude both the aneurysm and th e hypogastric artery, which was a potential source of retrograde flow to the aneurysm. Exclusion of the lesion and occlusion of the hypogast ric artery were demonstrated on delayed angiographic images and contra st computed tomography scans obtained at 16 days postprocedure. Unfort unately, the patient died 67 days following implantation from a nonpro cedure-related gastrointestinal complication. Results: At autopsy, the aortoiliac segment was excised and examined grossly and histologicall y; the evaluation confirmed complete isolation of the aneurysm by the fully expanded endoluminal prosthesis. The surface of the vascular gra ft was covered by a glistening, thin, fibrinous membrane. The graft ma terial was filled with hypocellular compact fibrinous material with no evidence of endothelialization. These observations confirm preliminar y sealing and isolation of the iliac artery aneurysm as healing of the endograft progressed. Conclusions: The data acquired from the analysi s of this specimen provide information regarding the utility and early healing of an endograft used for iliac artery aneurysm exclusion. Thi s case also exemplifies the utility of IVUS in endograft deployment.