EARLY RESULTS OF ENDOVASCULAR AORTIC-ANEURYSM SURGERY WITH AORTOUNIILIAC GRAFT, CONTRALATERAL ILIAC OCCLUSION, AND FEMOROFEMORAL BYPASS

Purpose: The aim of this study was to evaluate the feasibility of endo vascular aortic aneurysm repair with use of an aortouniiliac graft sec ured with self-expanding (Gianturco) stents. Methods: Thirty patients with a median age of 72 years (age range, 52 to 86 years) and aneurysm diameter of 6.0 cm (range, 4.0 to 9.0 cm) were treated with an aortou niiliac endovascular graft. Of these 30 procedures, 28 were carried ou t electively and two as emergencies for leaking aneurysm. Of the 30 pa tients, 21 (70%) were considered to be at high risk for open surgery. A modified Gianturco stent, Dacron graft, and Wallstent were used for these procedures. Results: Endovascular repair was successfully carrie d out in 25 of 30 (83.3%) patients. All these patients were mobile and had resumed a normal diet within 48 hours of the procedure. The overa ll 30-day mortality rate was two in 30 (6.6%), but it was one in 28 (3 .5%) for the elective cases; all deaths occurred in the group at high risk for surgery. Other complications encountered within 30 days of pr ocedure included myocardial infarction in one patient, pneumonia in tw o patients, homonymous quadrantanopia in one patient, and colonic isch emia in one patient, giving an overall morbidity rate of four in 30 (1 3.3%). At a median follow-up of 4 months (range, 1 to 13 months), 27 o f 30 (90%) patients remain alive and well. Conclusion: Endovascular ao rtouniiliac repair of abdominal aortic aneurysm with Gianturco stent i s feasible in both elective and emergency situations. It appears to be minimally traumatic, and the majority of patients deemed to be at hig h risk for open surgery can safely undergo endovascular repair. Howeve r, data on more patients with longer follow-up is required to determin e its role in the management of abdominal aortic aneurysm.