DELAYED RUPTURE OF AORTIC-ANEURYSMS FOLLOWING ENDOVASCULAR STENT GRAFTING

BACKGROUND: Deployment of transfemoral, endovascular stent grafts for treatment of abdominal aortic aneurysms is appealing for several reaso ns: avoidance of abdominal incision, lack of aortic cross-clamping, po tential for regional anesthesia, and shortened hospital stay. Concerns remain, however, regarding the ability of these devices to completely exclude the aneurysm and prevent aneurysm rupture and the long-term i ntegrity of the device. The availability of endografts and the likely development of percutaneous devices have also raised the delicate issu e of personnel training for patient selection, endograft implantation, and postoperative follow-up. PATIENTS AND METHODS: The cases of 2 pat ients are reported in which Dacron endovascular grafts, anchored proxi mally and distally by Palmaz stents, were deployed for treatment of in frarenal abdominal aortic aneurysms. RESULTS: In a patient with an abs ent distal cuff, choosing this procedure represented a clear error in patient selection, The endograft failed to reach the aortic bifurcatio n and the aneurysm ruptured, with the death of the patient 4 months po stimplantation, In a patient with anatomy suitable for endograft place ment, a perigraft leak persisted at the distal anastomosis following d evice placement. The aneurysm ruptured 14 days postprocedure. Although the patient survived emergent aneurysm repair, he developed acute ren al failure. CONCLUSION: Careful preoperative assessment of aortic anat omy is crucial in selection of patients for transfemoral endovascular graft placement, Lack of a distal cuff of at least 1 cm precludes tube graft implantation, Patients with a perigraft leak are not protected by the endograft from aneurysm rupture, Vascular surgeons must be invo lved in the preoperative evaluation of these patients and are the only specialty group who can provide the prerequisite care in evaluation a nd management of postoperative complications.