ENDOLUMINAL STENT-GRAFTS FOR INFRARENAL ABDOMINAL AORTIC-ANEURYSMS

Background The treatment of aortic aneurysms with endovascular stents or stent-graft prostheses is receiving increasing attention as an alte rnative to major abdominal surgery. To define the clinical value of th is technique, we prospectively studied the use of stent-graft endopros theses made of nitinol and covered with polyester fabric for the treat ment of infrarenal abdominal aortic aneurysms. Methods We treated a to tal of 154 patients at three academic hospitals. Twenty-one patients w ith aortic aneurysms not involving the aortic bifurcation received str aight stent-grafts, and 133 patients with aortic aneurysms involving t he bifurcation and the common iliac arteries received bifurcated stent -grafts. After a unilateral surgical arteriotomy, the endoprostheses w ere advanced through the femoral arteries and placed under fluoroscopi c guidance. Computed tomography and intraarterial angiography were per formed during an average follow-up of 12.5 months. Results The primary success rate, defined as complete exclusion of the abdominal aortic a neurysm from the circulation, was 86 percent in the group receiving st raight grafts and 87 percent in the group receiving bifurcated grafts. In three patients the procedure had to be converted to an open surgic al operation. Minor (n = 13) or major (n = 3) complications associated with the procedure (including 1 death) occurred in 10 percent of the patients. All patients had a postimplantation syndrome, with leukocyto sis and elevated C-reactive protein levels. Conclusions Our results su ggest that endovascular treatment of infrarenal abdominal aortic aneur ysms is technically feasible and can effectively exclude abdominal aor tic aneurysms from the circulation. With further refinement, endolumin al repair may emerge as an interventional strategy to treat infrarenal aortic aneurysms, especially in patients at high surgical risk. (C)19 97, Massachusetts Medical Society.