Bifurcated endograft in aortoiliac type C and D lesions: long-term results.

PURPOSE: To report long-term outcome when using a bifurcated aortic endograft for treatment of aortoiliac occlusive disease (AIOD) in Trans Atlantic Inter Society Consensus (TASC) classification C and D patients. MATERIALS AND METHODS: Between May 2001 and May 2009, 14 patients (11 men, 3 women) with aortoiliac TASC C and D type lesions and a mean age of 59 years ± 10 (range 41-73 years) were treated using a bifurcated aortic endograft. Although these patients were young, all were considered at high surgical risk. Patients were followed up clinically and by computed tomography (CT) every 3 months for 1 year and yearly thereafter. RESULTS: Endoprosthesis placement was performed in all patients with a technical success rate of 100%. There were no amputations or deaths at 30 days after the procedure. The mean follow-up was 62 months (range 11-96 months). One patient was lost during follow-up at 11 months, and another patient died of a nonrelated cause after 49 months. A single limb occlusion of the prosthesis was seen in two patients at 2 months and 7 months; both were successfully treated by intraarterial fibrinolysis. At a mean follow-up of 62 months, primary patency was 85.7%, and secondary patency was 100%. CONCLUSIONS: This series shows promising long-term results following the use of a bifurcated aortic endograft for treatment of AIOD TASC C and D type lesions. Bifurcated aortic endograft is a good minimally invasive alternative to open surgery in high surgical risk patients.

Bifurcated endograft (Excluder) in the treatment of isolated iliac artery aneurysm: preliminary report.

The aim of this study was to evaluate the effectiveness of endovascular repair in the treatment of isolated iliac artery aneurysm (IAA) using Excluder bifurcated endograft. Eight consecutive patients with IAA were treated during a period of 45 months using Excluder bifurcated endograft. Two patients presented with isolated IAA rupture and were treated emergently, whereas the other six patients underwent elective treatment. All aneurysms lacked sufficient proximal necks and therefore were not suitable for tubular-shaped endograft. Follow-up imaging was performed at 1 week, at every 3 months during the first year, semiannually until 2 years, and annually afterward using angio-computed axial tomography and plain films. Technical success was achieved in all patients. No mortality was seen despite two patients having IAA rupture. Follow-up (12 to 60 months) was done in all but one patient. During this period, complications were observed in three patients. One patient developed sexual impotence at 3-month follow up; one patient presented unilateral gluteal claudication after the procedure, which resolved at 3 months; and one patient developed a graft porosity-related endoleak, which was successfully managed with placement of an additional ipsilateral iliac extension. Endovascular treatment of isolated IAA using bifurcated endograft is safe and can be an alternative to surgical treatment. The benefits from decreased morbidity and mortality of endoluminal treatment of isolated IAA using bifurcated endograft outweigh the minor complications associated with this technique, which are mostly related to occlusion of hypogastric arteries.

Clinical follow-up in endovascular treatment for TASC C-D lesions in femoro-popliteal segment.

OBJECTIVE: To demonstrate the technical success and clinical follow-up after endovascular treatment of femoropopliteal segment TASC II C and D lesions. METHODS: From July 2002 to February 2007, 234 limbs in 190 patients with femoropopliteal segment TASC II C (n = 112) and D (n = 122) lesions were treated. Endovascular treatment consisted of PTA, fibrinolysis and PTA, subintimal recanalization and PTA, and finally stent graft. Patients were clinically evaluated at 30 days, 3, 6 month, and at 1 year in the outpatient setting with clinical examination and ankle-brachial indices (ABI). In the case of stent placement, additional ultrasound evaluation was performed at 12, 24, and 48 month. RESULTS: 49.5% of procedures were performed on patients with lifestyle-limiting claudication (IC) and 50.5% were performed for critical limb ischemia (CLI). Technical success, defined as successful recanalization and treatment of the occluded vessel, was achieved in 97% of cases. Periprocedural mortality was 3.15% and all deaths occurred in the CLI group. A follow-up 13 +/- 6 months and was achieved in 76%. During the follow-up, clinical outcome for IC group and clinical CLI group was asymptomatic 72% vs. 29.8%, symptomatic with clinical improvement 22% vs. 33.7%, and major amputation 3% vs. 23.3%. CONCLUSION: The majority of claudicating patients with femoropopliteal TASC II C and D lesions will benefit from the endovascular treatment. Patient presenting CLI have a worse outcome, nevertheless the endovascular treatment can delay amputation, preserving the native vessel and does not impede surgical bypass if needed. For this reason, we consider that endovascular treatment may be the first choice treatment even in femoropopliteal TASC II C and D lesions.

Intimal dehiscence in the abdominal aorta following balloon fenestration for type B dissection.

PURPOSE: To report a case of intimal dehiscence associated with endovascular intervention in patients with aortic dissection. CASE REPORT: A 65-year-old man presented with a type B dissection extending to the level of the common iliac arteries. Two Talent stent-grafts were placed in the descending thoracic aorta to close the entry point, but 2 lumens remained. Three days later, abdominal pain prompted another imaging session, which demonstrated a large cylindrical filling defect in the abdominal aorta ("tube-in-tube") assumed to be a partially or completely dehisced intima. Fenestration marginally improved flow to the visceral vessels, and the patient improved clinically. However, 4 days later, recurrent ischemic symptoms prompted surgery; a complete dehiscence of the aortic intima starting at the descending aorta extended to the distal abdominal aorta. The aorta was resected, but the patient died from disseminated intravascular coagulation. CONCLUSIONS: Intimal flap dehiscence associated with an endovascular procedure in the management of aortic dissection is an uncommon complication. Early detection and prompt surgical intervention of such a complication could save the patient's life. Endovascular procedures are unlikely to resolve the hemodynamic problem caused by a dehisced, distally migrated, collapsed intima.

Bifurcated endoprosthesis for treatment of aortoiliac occlusive lesions.

PURPOSE: To report our initial experience with a bifurcated endoprosthesis in the management of aortoiliac occlusive disease. METHODS: From May 2001 to February 2004, 112 patients were referred to our institution for the management of aortoiliac disease. Among these, 5 (6%) patients (3 men; mean age 57.8 years) with severe ischemia owing to TASC C or D iliac occlusions were selected for endovascular treatment with a bifurcated stent-graft. An Excluder stent-graft was placed after preliminary recanalization (thrombolysis and/or balloon dilation) the day before. The patients were followed clinically and ultrasonographically every 3 months during the first year and semiannually thereafter. RESULTS: Technical success was achieved in all patients. Endovascular aortoiliac bifurcation reconstruction restored iliac artery flow immediately in all cases. There were no procedure-related complications. The mean ankle-brachial index (ABI) was significantly improved, from 0.66+/-0.04 before the procedure to 0.94+/-0.06 immediately after the procedure (p<0.01). The aortoiliac reconstructions remained patent during the mean 17-month follow-up (range 3-36), and the ABIs were stable. There was no mortality or amputation required in this series. CONCLUSIONS: Endovascular placement of a bifurcated stent-graft appears to be technically feasible, effective, and safe in the management of aortoiliac occlusive disease.

Disc erosion in Models 103 and 104 of Beall mitral valve prostheses.

Three cases of severe disc variance and erosion of the Teflon-disc Beall mitral valve prosthesis (Models 103 and 104) are reported. In two patients, the Beall mitral valves were excised and replaced with two Björk-Shiley mitral valves. The remaining patient did not survive, and at autopsy, the lens was found at the aortic bifurcation level. Because of this potentially lethal complication, careful follow-up of patients with Beall mitral valve prostheses (Models 103 and 104) is recommended.