Failure of endovascular abdominal aortic aneurysm graft limbs

Objective: Endovascular abdominal aortic aneurysm (AAA) grafts are subject to subsequent failure of endograft limbs. We sought to determine what devic e-related factors could be identified that might contribute to limb failure . Methods: We reviewed the records of patients who had undergone endovascular AAA repair and femorofemoral bypass grafting at a single institution. Results: Endovascular AAA repair was performed in 173 patients. There were 137 bifurcated endografts and 36 aortomonoiliac grafts combined with femoro femoral bypass grafts, yielding a total population of 310 aortic graft limb s and 36 femorofemoral grafts. Thirty-nine additional patients underwent fe morofemoral bypass grafting for occlusive disease. The cumulative primary p atency of all endografts performed for AAA was 92% at 21 months. Secondary patency was achieved for all failed endograft limbs. There were 24 aortic g raft limb "failures" that required intervention: seven limbs underwent thro mbosis requiring revision; kinked limbs requiring stenting either at the ti me of graft placement (17) or subsequently (7) were identified. Fully suppo rted endograft limbs had better primary patency (97% at 18 months) than uns upported limbs (69% at 18 months, P <.001). The aortomonoiliac grafts with femorofemoral bypass grafts tended to have better patency (97% at 18 months ) than bifurcated endografts (90% at 18 months), but this did not reach sta tistical significance (P = .28, not significant). Femorofemoral grafts perf ormed for occlusive disease were found to have somewhat lower patency than those performed for AAA (83% vs 92% at 18 months of follow-up, P = .37, not significant). Conclusions: fully supported AAA endografts provide superior endograft limb patency compared with unsupported designs. Consideration should be given t o routine stenting of all unsupported endograft limbs. Aortomonoiliac graft s and bifurcated grafts provide similar results for endograft limb patency. Femorofemoral bypass grafts performed in conjunction with aortomonoiliac g rafts for ABA disease provide excellent short-term patency.