Endovascular abdominal aortic aneurysm repair with percutaneous transfemoral prostheses deployment under local anaesthesia. Initial experience with anew, simple-to-use tubular and bifurcated device in the first 27 cases

Background: modification of endografts are required to simplify and improve the safety of the endovascular management of abdominal aortic aneurysms (A AA). Objectives: the aim of this study is to evaluate the efficacy of a new cust om-made, tubular and bifurcated device. Materials and method: the graft consisted of a continuous, self-expanding, stainless steel, Z-stent structure, covered with a thin wall PTFE tube. Bif urcated grafts mere constructed in vivo from three PTFE tubes with a contin uous Z-stent structure. Twenty-seven high risk patients with a mean age of 74 (62-86) years and AAA, mean diameter 5.9 cm, were treated in the last 26 months. Tube grafts were deployed in 13 aortic and one iliac cases, bifurc ated grafts in nine cases and aorto-uni-iliac grafts with femorofemoral byp ass in four cases. Crafts were deployed percutaneously under local anaesthe sia. Patients were followed with contrast CT periodically. Results: all grafts were deployed. There were no open conversions or other major complications. There were nine proximal and one distal postoperative; endoleak. Four sealed spontaneously, three were treated successfully with endovascular techniques and three are under surveillance. In the 7 (2-23) m onths follow-up, one patient died due to heart failure 3 months post-proced ure. Conclusions: local anaesthesia and percutaneous graft introduction simplify and improve the efficacy of the procedure. Continuous aortic graft support provides stability and reduces the risk of migration. PTFE is a flexible, low-profile material for use in endovascular stentgrafts. The bifurcation c oncept used offers a simple technique for bifurcated grafts.