[Results and complications after endovascular reconstruction of aortic aneurysms]

Between August 1994 and December 1996 137 patients (10 female and 127 male, mean age 66 yrs., range 27-85) with aortoiliac aneurysmal disease were treated with endovascular stent grafts. Pathology included 5 thoracic, 131 abdominal and 1 isolated iliac artery aneurysm. 88 straight tube grafts (75 Mintec, 12 EVT, 1 Chuter) and 43 bifurcated grafts (21 Mintec, 20 EVT, 2 Chuter) were implanted in the infrarenal aorta. 5 (Mintec) tube grafts were used for the thoracic aneurysms. One tapered tube graft was used to exclude the isolated iliac aneurysm. 11 patients (8%) required conversion to open surgical repair. This was due to defective devices in 5, device related occlusion of a renal artery in 2, aortic dissection in 1, occlusion of iliac outflow in 1, a large unmanageable proximal endoleak in 1 and a retroperitoneal bleeding resulting in hemorrhagic shock in 1 patient. There was one procedure related death for a mortality of 0.7%. Patients were followed every 3-6 months using CT with i.v. contrast and ultrasound duplex examinations with adjunctive usage of an intravenous ultrasound contrast agent (Levovist, Schering AG). Intraarterial DSA was used only when called for by thrombotic or stenotic complications. At a mean follow-up of 9.2 months (range 2-24 months) 16 (17%) primary and 8 (8.5%) secondary leaks (at the distal anchoring zone) were detected after implantation of tube grafts. 11 (25.6%) leaks were detected after implantation of bifurcated grafts. Iliac artery occlusion was observed in 2 patients after placement of a straight endograft, 6 times after reconstruction with a Mintec bifurcated device and 3 times after implantation of an EVT bifurcated endograft. Successful treatment of iliac artery occlusion without the need for subsequent amputation or major disability included extraanatomic bypass in 7 patients, PTA (3 patients) and implantation of wallstents (2 patients) or conservative management (1 patient).