ABSTRACT
BACKGROUND: To present an unusual case of blunt aortic injury in a 30-year-old male patient with an aberrant right subclavian artery. METHODS AND RESULTS: Driven by the complicated and challenging nature of the case, we decided to treat the patient by a combined approach-right subclavian artery transposition and endograft implantation at the isthmus level. During the 24-month follow-up (clinical examination, angiogram, computed tomographic scan), we registered no complaints; normal perfusion of the right arm; and adequate sealing of the aortic tear. CONCLUSIONS: We believe that the hybrid management of such trauma is a feasible, effective, and less-invasive option.
Subject(s)
Aneurysm/surgery , Aortic Rupture/surgery , Blood Vessel Prosthesis Implantation , Cardiovascular Abnormalities/surgery , Deglutition Disorders/surgery , Endovascular Procedures , Vascular System Injuries/complications , Vascular System Injuries/surgery , Wounds, Nonpenetrating/surgery , Adult , Aneurysm/complications , Aneurysm/diagnostic imaging , Angiography, Digital Subtraction , Aortic Rupture/complications , Aortic Rupture/diagnostic imaging , Aortography/methods , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/instrumentation , Cardiovascular Abnormalities/complications , Cardiovascular Abnormalities/diagnostic imaging , Deglutition Disorders/complications , Deglutition Disorders/diagnostic imaging , Endovascular Procedures/instrumentation , Humans , Male , Prosthesis Design , Stents , Subclavian Artery/abnormalities , Subclavian Artery/diagnostic imaging , Subclavian Artery/surgery , Tomography, X-Ray Computed , Treatment Outcome , Vascular System Injuries/diagnostic imaging , Wounds, Nonpenetrating/complications , Wounds, Nonpenetrating/diagnostic imagingABSTRACT
PURPOSE: To evaluate the feasibility and efficacy of repairing isolated iliac artery aneurysms with short proximal necks (<10 mm) by implanting the EndoFit stent-graft. METHODS: Seven patients (6 men; median age 73 years, range 70-78) were diagnosed with an isolated common iliac artery (CIA) aneurysm that featured a short proximal landing zone, complicating endovascular treatment. The median aneurysm diameter was 4.4 cm (range 3.5-7.0), and the median proximal neck length was 7 mm (range 5-9).The aneurysms were treated using the EndoFit stent-graft, which can be deployed in a short proximal landing zone. The modified technique involves the deployment of the graft directly above the aneurysm sac without obstructing the contralateral iliac axis, thus affixing the bare proximal stent in the terminal aorta. Follow-up was performed by clinical evaluation and computed tomography at 1, 6, and 12 months postoperatively. RESULTS: The EndoFit stent-graft was successfully deployed in all cases, with complete aneurysm exclusion. In 1 case, the deployment of a second cuff was necessary to secure complete aneurysm exclusion. The median follow-up was 18 months, during which no deaths occurred, and no endoleak or stent-graft migration was observed. Endograft thrombosis occurred in 1 case due to graft angulation caused by external iliac artery stenosis and kinking. None of the aneurysms has ruptured, and there have been no serious complications. CONCLUSION: Direct endoluminal repair of isolated CIA aneurysms with short proximal necks is feasible using this technique. Efficacy and long-term results are to be confirmed by larger scale series over a long time period.
Subject(s)
Iliac Aneurysm/pathology , Iliac Aneurysm/surgery , Stents , Aged , Blood Vessel Prosthesis Implantation , Feasibility Studies , Female , Femoral Artery/diagnostic imaging , Femoral Artery/pathology , Femoral Artery/physiopathology , Femoral Artery/surgery , Follow-Up Studies , Graft Occlusion, Vascular/diagnostic imaging , Graft Occlusion, Vascular/etiology , Graft Occlusion, Vascular/physiopathology , Graft Occlusion, Vascular/surgery , Humans , Iliac Aneurysm/physiopathology , Male , Prosthesis Design/instrumentation , Reoperation , Retrospective Studies , Tomography, X-Ray Computed , Treatment Outcome , Vascular PatencyABSTRACT
PURPOSE: To evaluate the feasibility and efficacy of a specific aortomonoiliac endograft and the durability of the femorofemoral bypass for treatment of abdominal aortic aneurysm (AAA). METHODS: From 2002 to 2004, 39 high-risk (ASA III/IV) patients (36 men; median age 74 years, range 63-84) with AAA (n = 33) or AAA and common iliac artery aneurysm (n = 6) were treated with an EndoFit aortomonoiliac endograft and femorofemoral crossover bypass. The contralateral iliac axis was obstructed with an endoluminal occluder. Patients were followed with contrast-enhanced computed tomography at 1, 6, 12, and 24 months. RESULTS: EndoFit AMI stent-grafts were implanted successfully in all patients. Perioperative mortality was zero. Endoleak occurred in 3 (7.7%) cases. A proximal type I endoleak was identified at 1 month and was treated with a proximal cuff. Two type II endoleaks are under surveillance because the aneurysm sac shows no enlargement. Thrombosis of the femorofemoral graft occurred in 1 case during the immediate postoperative period due to insufficient inflow from a residual stenosis of the endograft (primary patency 97.5%). The deficit was treated successfully (secondary patency 100%). Two (5.1%) tunnel hematomas were treated conventionally. Median follow-up was 14 months (range 6-30). All patients are alive. None of the aneurysms has ruptured or been converted to an open procedure. Graft migration, serious infection, paraplegia, distal embolization, or any other serious complication has not been observed. CONCLUSIONS: In high surgical risk patients with complex iliac anatomy, aortomonoiliac endograft with femorofemoral crossover bypass is feasible and efficacious. Moreover, the midterm patency of the extra-anatomic bypass appears quite satisfactory.
