Experience with endovascular grafts in the treatment of infrarenal aortic aneurysms associated with proximal aortic dissection

BACKGROUND: Chronic abdominal and thoracic aortic dissections often present with concomitant infrarenal aortic dilatation. We conducted a retrospectiv e review of 8 patients treated with endovascular stent grafts for coexistin g aortic dissection and infrarenal aneurysm. METHODS: Six patients with suprarenal aortic dissections and infrarenal aor tic aneurysms (AAA) had their AAAs treated with endovascular grafts. Crafts were constructed of balloon expandable Palmaz stents and expanded polytetr afluoroethylene graft. The device was inserted transfemorally and deployed under fluoroscopy. RESULTS: Successfully primary AAA exclusion was achieved in 5 patients. One patient required a supplemental stent placed above the endograft and into the true lumen to seal the endoleak. No aneurysm has enlarged, and all rema in thrombosed for 9 to 24 months (mean 20). One type III dissection enlarge d 2 weeks alter endograft insertion. One patient had uncomplicated cephalad fenestration of a dissection by the endograft. CONCLUSIONS: Endovascular grafts may be used to treat coexisting AAA and ao rtic dissection. Attention to the site or sites of reentry of a dissection is essential to insure full aortic aneurysm exclusion. The fate of a chroni c aortic dissection cephalad to an endovascularly treated AAA is unclear an d will require longer follow-up. (C) 1999 by Excerpta Medica, Inc.