Early experience with the bifurcated Excluder endoprosthesis for treatmentof the abdominal aortic aneurysm

Purpose: This report describes our initial experience with the modular, bif urcated Excluder endoprosthesis and its safety and efficacy in the primary endovascular repair of infrarenal abdominal aortic aneurysms (AAAs). Methods: AAAs (mean diameter, 58.2 +/- 14.3 mm) were repaired in 19 patient s with this device between March 1999 and January 2000. The mean age of pat ients was 71.8 +/- 8.4 years (range, 57-86 years). This modular device was inserted through an 18F introducer sheath placed in one femoral artery, and the contralateral artery was cannulated with a 12F introducer sheath. All procedures were performed in a standard operating room with angiographic ca pabilities. Results: Endograft deployment was successful in all patients. The average s urgical time was 135 +/- 37 minutes, with a mean blood loss of 229 +/- 138 mL. In eight patients, the use of either aortic or iliac extenders was requ ired for enhanced sealing or additional length. An external iliac artery di ssection occurring at the time of endograft insertion was successfully trea ted with a Wallstent. Type II leaks initially found to be present by means of intraoperative completion angiography had spontaneously thrombosed by th e 1-month follow-up computed tomography scan. There was one perioperative d eath (5.3%). Complications included superficial wound infections (n = 3) an d a nonfatal myocardial infarction (n = 1). The mean length of hospital sta y was 2.9 +/- 1.2 days, and only six patients required intensive care. Endo leaks were seen in four patients (21%) by means of the 30-day computed tomo graphy scan; three of these endoleaks had spontaneously sealed at the time of the 6-month follow-up examination (5.5% 6-month endoleak rate). Aneurysm size did not increase in the patients with leaks. Conclusion: The Excluder endoprosthesis was an effective means of excluding an infrarenal AAA from the systemic circulation in this selected group of patients. The smaller sheath sizes may increase the pool of potential candi dates. Further study of this device is warranted, and continued assessment of the long-term durability of the device win be necessary.