AORTOMONOILIAC ENDOVASCULAR GRAFTING - DIFFICULT SOLUTIONS TO DIFFICULT ANEURYSMS

Purpose: To describe a refined technique for aortomonoiliac endograft exclusion of abdominal aortic aneurysms (AAAs). Methods:A tapered aort omonoiliac graft was prepared from an 8-mm thin-walled expanded polyte trafluoroethylene tube graft predilated proximally to 35 mm and tapere d distally to 15 mm. The proximal graft was sutured to a 5-cm-long, pr edilated Palmaz stent, which was mounted on a 30-mm balloon and backlo aded into a 21F packaging sheath. With the patient under general anest hesia and both common femoral arteries exposed, the endograft was anch ored in the infrarenal aorta and subsequently passed into one iliac sy stem, where it was anastomosed to the iliac or femoral vessels. The co ntralateral common iliac artery was occluded, and an extra-anatomic, f emorofemoral, or iliofemoral bypass grafting was performed. Results: T wenty of the 25 AAAs treated to date with this technique have been suc cessful, with aneurysm exclusion achieved in 18 (2 minor distal endole aks are scheduled for endovascular repair). The technical failures wer e analyzed, resulting in enhancements to the technique. Complications included 2 early (< 30 days) deaths, 1 case of minor embolization, 1 t ransient renal failure, 1 pulmonary embolus, and 1 wound infection. Th e only late complication was a graft infection localized to the groin. Conclusions: Aortomonoiliac endovascular aneurysm repair is effective in patients with AAAs involving the iliac arteries. Short-term result s are acceptable, but long-term efficacy must be addressed before this procedure is widely adopted. Technical changes made in response to ea rly learning curve problems have led to a safer, more reliable procedu re.