Quality control during endovascular aneurysm repair: Monitoring aneurysmalsac pressure and superficial femoral artery flow velocity

Purpose: To use intraoperative aneurysmal sac pressure measurement and flow monitoring of the superficial femoral artery (SFA) to ensure complete excl usion of the aneurysm from the circulation. Methods: A 5F catheter was positioned in the aneurysmal sac of 15 consecuti ve patients undergoing endovascular aortomonoiliac aneurysm repair between February and September 1997. The catheter was connected to an external pres sure transducer allowing pressure monitoring throughout the operation and f or 24 hours postprocedurally. Flow velocity was monitored in the contralate ral SFA by insonation with a 2-MHz Doppler ultrasound probe. Results: No technical defect was observed in the deployment of 10 endograft s, which demonstrated marked reduction in sac pressure and good flow in the lower limb. The mean aneurysm pressure dropped from 123 to 57 mmHg after g raft insertion. In 5 cases, monitoring detected problems during the endogra ft procedure. In 3, incomplete stent deployment was detected by a failure o f sac pressure to fall following stent inflation and by the presence of flo w in the contra lateral femoral artery. In the other 2 cases, a distal endo leak was detected by direct injection of contrast into the sac. Conclusions: Measuring aneurysm pressure in combination with SFA Doppler fl ow monitoring can detect complications of endovascular aneurysm repair.