3-YEAR EXPERIENCE WITH MODULAR STENT-GRAFT DEVICES FOR ENDOVASCULAR AAA TREATMENT

Purpose: To evaluate feasibility and present early results of endovasc ular abdominal aortic aneurysm (AAA) exclusion using modular stent-gra fts. Methods: In a 3-year period ending July 1997, 201 patients were t reated with self-expanding stent-g rafts for AAAs with inf ra renal ne cks greater than or equal to 10 to 15 mm long and less than or equal t o 32 mm wide; subtotal mural thrombus, calcification, and even angulat ion to some extent were acceptable, as were iliac arteries up to 18 mm wide. The patients were treated with either the Stentor/Vanguard devi ce (178 cases) or the Talent endograft (23 cases). Follow-up on all pa tients was conducted at 3, 6, 12, 18, and 24 months. Results: The tech nical aneurysm exclusion rate was 89% (178/201). There were 18 primary endoleaks (9.0%; 2 proximal, 16 distal), 4 (2.0%) conversions to open surgery, and 1 (0.5%) failure to deploy the graft. Seven (3.5%) patie nts died in the perioperative period, 5 due to multiorgan failure earl y in the series and two of hemorrhagic complications. Five (2.5%) rena l artery occlusions were encountered; in one case, the graft was remov ed after 3 weeks. Nineteen late endoleaks were found in follow-up, rel ated primarily to the iliac limb graft extensions of the Stenter devic e, graft material problems, or unknown causes. To date, 10 primary and 13 secondary endoleaks have been treated endovascularly. Twenty (10.0 %) graft-limb thromboses were treated either by thrombolysis, thrombec tomy, or a femorofemoral bypass. Conclusions: Endovascular grafting is technically feasible and becomes easier with improvements of the intr oducer systems and the grafts. The seemingly high complication rate in this series is due to the liberal patient selection criteria.