TREATMENT OF COMPLEX ABDOMINAL AORTIC-ANEURYSMS BY A COMBINATION OF ENDOLUMINAL AND EXTRALUMINAL AORTOFEMORAL GRAFTS

Purpose: The purpose of this study was to test the hypothesis that abd ominal aortic aneurysms (AAA) whose morphology makes them unsuited for repair with an endoluminal tube graft can be treated by a combination of a transluminally placed aortofemoral graft and a femorofemoral cro ssover graft. In addition the technique involves either ligation or ba lloon occlusion of the contralateral common iliac and internal iliac a rteries in such a manner that excludes the AAA from the circulation. M ethods: We report the use of this technique in three male patients wit h 6.4 to 7.0 cm diameter AAA. Two had renal impairment and cardiac fun ction too poor to permit open repair, and the third had an unfavorable abdomen caused by previous surgery and the presence of a permanent co lostomy. Each patient had an individually tailored Dacron tube graft c onstructed on the basis of preoperative arteriograms and computed tomo graphy scans. The grafts were delivered transluminally into the aorta through a sheath in the iliac arteries and anchored proximally with a stainless steel stent under radiographic control. The grafts were then anastomosed distally to the femoral artery. Results: Recovery was com plicated by a midgraft stenosis corrected by percutaneous balloon dila tion in one patient, an episode of pulmonary edema in the second and a n unexplained pyrexia in the third. Follow-up with duplex scanning con firmed normal flow through the grafts and the presence of thrombus bet ween the prosthetic graft and the aneurysmal sac. Conclusions: We conc lude that transluminal placement of an aortofemoral graft combined wit h a femorofemoral crossover graft is feasible in patients who are unsu ited to repair with an endoluminal tube graft. The outcome with this t echnique is not known and requires further careful evaluation.