Endovascular stent grafts for aneurysmal and occlusive vascular disease

BACKGROUND: This report details our initial experience with two types of en dovascular grafts-one for the treatment of infrarenal abdominal aortic aneu rysms and the other for the treatment of iliac artery occlusive disease. METHODS: An abdominal aortic aneurysm was repaired in 34 patients using 3 d ifferent types of Ancure endografts (Menlo Park, California). Control patie nts (n = 9) had a standard aneurysm repair. Patients with chronic lower ext remity ischemia (n = 7) secondary to iliac artery occlusive disease were tr eated with a Hemobahn endograft (W. L. Gore & Associates, Flagstaff, Arizon a). RESULTS: Ancure graft deployment was achieved in 33 of 34 (97.1%) patients. Perioperative mortality for the Ancure and control group patients was 2.9% and 0%, respectively. Periprosthetic leaks were identified within 48 hours of deployment in 6 (18.2%) Ancure graft patients. All but 2 of the leaks r esolved on serial follow-up. Additional endovascular procedures were requir ed in 11 (32.4%) Ancure graft patients at the initial procedure or during f ollow-up to correct graft or arterial stenoses. Patients treated with an en dovascular graft had significantly less blood loss and shorter hospital sta ys than control group patients. For Hemobahn patients, the technical succes s for graft deployment was 100%. There were no perioperative deaths. The an kle/brachial index increased from a mean of 0.52 preoperatively to 0.86 pos toperatively (P = 0.004). One patient required a Wallstent in follow-up to correct a graft wrinkle. Angiography at 6 months demonstrated mild intimal hyperplasia in the stent graft in 5 of 6 patients. CONCLUSIONS: These early results support the potential for endovascular gra fts in the treatment of aneurysmal and occlusive vascular disease. Further modifications in the devices and deployment techniques are necessary to red uce the incidence of periprosthetic leaks, graft limb stenoses, and intimal hyperplasia. Am J Surg. 1998; 176:574-580. (C) 1998 by Excerpta Medica, In c.