Endovascular repair of aortic aneurysms, arteriovenous fistulas, and false aneurysms

Between September 1990 and June 1995, 103 patients were treated with transluminal placed endovascular grafts: 87 had abdominal aortic aneurysms (AAA), two had iliac artery aneurysms (one in association with an AAA), 3 had thoracic aneurysms, and 12 had vascular injuries in various localization of the arterial tree. The AAAs were excluded from the blood flow with a device composed of a balloon-expandable stent (modification of the Palmaz stent) attached to a Dacron graft designed to expand at both ends of the accompanying stent extension. An 18F sheath containing the stent-graft device was introduced through a small cut-down in the common femoral arteries and advanced under fluoroscopic guidance. Color duplex, contrast-enhanced computed tomography (CT) scanning and angiography were performed before the procedure and then every 6 months. (Arteriography was performed once during the follow-up period and whenever other studies disclosed an abnormal finding.) A total of 87 patients (75 men, 12 women) harboring an AAA were treated: Forty-five patients underwent an aortoaortic procedure (8 patients had only a proximal stent implanted, and 37 had proximal and distal stents). Forty-two patients were treated by implanting an aortoiliac graft, completing the procedure with a femorofemoral bypass. The contralateral common iliac artery was occluded by means of an occluding stent. One type A dissecting aneurysm and two descending thoracic aneurysms were successfully treated by the endovascular technique. The longest follow-up period was 60 months and the shortest 1 month. Initial success was obtained in 84% of the aortoaortic cases and in 75% of the aortoiliac procedures. Long-term follow-up (> 12 months) disclosed 78% success for the aortoaortic cases and 90% for the aortoiliac procedures. Late failures included distal aortic dilatation, distal leak into the aneurysmal cavity, and proximal leak into the aneurysm. All trauma cases were successful over the short and long terms. Trauma cases included false aneurysms (common carotid, subclavian, common femoral arteries) and arteriovenous fistulas (subclavian, aortocava, common iliac-cava and superficial femoral artery and vein). We concluded that stent-graft combination devices appear to be an alternative for treating vascular trauma and aneurysms. Initial success for treating AAAs is almost 100%, and late success in aortoiliac cases is also high (90%) for aortoaortic reconstruction. However, late failures are frequent and require further evaluation in relation to a persistent increase in the diameter of the proximal neck and distal cuff.