ENDOVASCULAR REPAIR OF AN ASCENDING AORTA-TO-LEFT COMMON FEMORAL-ARTERY GRAFT WITH ANEURYSMAL DEGENERATION

Purpose: To report the use of endovascular grafting to repair degenera tive aneurysmal changes in an extra-anatomic bypass graft. Methods: A 14-year-old extra-anatomic ascending aorta-to-left common femoral bypa ss graft (''ventral aorta'') had undergone aneurysmal degeneration, pr oducing symptoms of progressive claudication and local abdominal swell ing. The aneurysmal graft dilatation began within the thoracic cavity and extended through the entire extraperitoneal abdominal segment. The option for minimally invasive repair using a customized stent-graft d evice was offered to the patient as an alternative to standard reopera tion. Results: An 8-mm x 42-cm endovascular graft was constructed of p olytetrafluoroethylene with 30-mm Palmaz stents sutured to each end. W ith balloon occlusion of antegrade and retrograde blood flow, the sten t-graft was delivered retrograde through an incision in the distal end of the existing bypass graft. The device was successfully positioned and deployed with complete exclusion of the aneurysm. No complications occurred, and the patient's symptoms abated. Follow-up arteriography at 1 month showed a pseudoaneurysm at the distal graft incision site; surgical repair was necessary. At 6 months, angiography demonstrated c ontinued patency of the extra-anatomic bypass graft. Conclusions: Intr aluminal aneurysm exclusion techniques in degenerated extra-anatomic b ypass grafts may evolve into a viable therapeutic alternative to compl ex reoperative surgery.