OCCLUDING AORTIC ENDOLUMINAL STENT GRAFT COMBINED WITH EXTRAANATOMIC AXILLOFEMORAL BYPASS AS ALTERNATIVE MANAGEMENT OF ABDOMINAL AORTIC-ANEURYSMS FOR PATIENTS AT HIGH-RISK WITH COMPLEX ANATOMIC FEATURES - A PRELIMINARY-REPORT

Purpose: To describe an exclusion endoluminal technique for management of abdominal aortic aneurysms among high-risk patients with complex a natomic features. Methods From January 1995 to December 1996, among 14 3 patients with infrarenal abdominal aortic aneurysm treated by means of endograft placement, 9 (6.3%) had complex aortic or aortoiliac morp hologic features. For these patients, the endograft was delivered thro ugh a femoral cutdown in an occluding aortoiliac configuration. The co ntralateral iliac artery was occluded with an iliac endograft. Axillof emoral bypass grafting was performed. Computed tomographic scans were obtained regularly. Results: There was 1 postoperative death of severe arrhythmia. All aneurysms were found to be affected by thrombosis on immediately postoperative computed tomographic scans, except in 1 pati ent with a proximal leak, which was managed successfully with angiogra phic embolization. The mean follow-up time was 12 months. Aortic aneur ysm diameter decreased from 2 mm at 6 months (2 patients) to 6 mm at 1 2 months (6 patients). All axillofemoral bypass grafts are patent. Con clusions: Placement of an occluding endogaft associated with axillofem oral bypass grafting is a good alternative for patients at high risk w ith complex anatomic features. Longer-term follow-up study is needed t o evaluate this endoluminal technique.