EVT (R) endovascular graft for abdominal aortic anerysm

Background: A variety of prostheses are now available for the endovascular treatment of abdominal aortic aneurysm (AAA). Significant advantages of the EVTz (R) device are its unibody design, secure hook attachment system and graft fabric approximating that used in conventional surgery. Methods: Implantation of the EVT (R) device was attempted in 60 patients wh o were studied prospectively with an analysis of subsequent problems encoun tered. Results: Conversion to open repair was required in four cases (6.7%). There were nine tube grafts inserted, 13 aorto-unilateral iliac with crossover g rafts and 34 aorto-bi-iliac grafts. There was one death (mortality 1.7%). E ndoleaks were identified in eight patients (14%), none of which were proxim al; three sealed spontaneously, two were treated with coil embolization, tw o are being observed and one patient had an iliac attachment converted to a n open anastomosis. Access vessel problems were seen in 21 patients (35%); two-thirds were corrected at the time of initial surgery. Seven patients (1 2%) had primary graft limb problems identified and treated before leaving t he operating room. Nine patients (16%) developed secondary graft limb probl ems, which were diagnosed and treated after the initial surgery. Endovascul ar treatment was used in eight and was successful in six with surgical revi sion required in two. On review of these cases to assess if the problem cou ld have been predicted at the time of initial surgery, it was felt that mor e aggressive treatment of intraoperatively diagnosed graft limb stenoses, e ven though considered mild, may have prevented 50% of subsequent secondary graft limb occlusions. Conclusion: Although the EVT(R) device has significant advantages in the en dovascular management of aortic aneurysm, potential graft limb problems nee d to be actively identified with the majority able to be successfully manag ed by supplementary endovascular techniques.