Endovascular treatment of iliac limb stenoses or occlusions in 31 patientstreated with the ancure endograft

PURPOSE: The authors report their experience with treatment of iliac limb c omplications in patients treated with the Ancure endograft with Wallstents to provide additional support and thrombolysis when needed. MATERIALS AND METHODS: From February 1996 to October 1999, 88 patients were treated for abdominal aortic aneurysm with use of the Ancure endograft, Of the 88 devices used, 20 were tube grafts and the remaining 68 devices had a total of 130 iliac limbs (bifurcated, n = 62; aortoiliac, n = 6), After g raft deployment, all patients underwent intraoperative aortography; since J uly 1997, intravascular ultrasound (IVUS) has also been used. RESULTS: Thirty-one patients (46%) required treatment of 47 (36%) limbs wit h Wallstents. Graft narrowing was observed in 41 limbs (27 patients) with I VUS immediately after graft deployment. All were successfully treated with placement of Wallstents, Before routine use of intraoperative IVUS, three p atients presented between 2 and 6 weeks postoperatively with iliac limb thr ombosis, All three limbs were successfully treated with thrombolysis and Wa llstent placement to correct the underlying iliac problem, Additionally, tw o contralateral limbs in these three patients were also noted to have steno sis and were treated with use of Wallstents. The last patient required plac ement of a Wallstent to treat stenosis of surgical anastomosis of the iliac limb of an aortoiliac endograft at 3 days. All Wallstent-reinforced Ancure endografts remained patent from 1 to 36 months (mean, 14 months). CONCLUSION: After placement of an Ancure bifurcated or aortoiliac endograft , iliac limb stenosis is easily detected with use of intraoperative IVUS, S uch complications can be safely corrected with Wallstent placement. Postope rative limb occlusion at the authors' institution has been eliminated with such intervention.