| 1. |
- Ivancev, Krassi, et al.
(författare)
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Abdominal aortic aneurysms: experience with the Ivancev-Malmo endovascular system for aortomonoiliac stent-grafts
- 1997
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Ingår i: Journal of Endovascular Surgery. - 1074-6218. ; 4:3, s. 242-251
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To describe a component-based aortomonoiliac stent-graft system and the first clinical results achieved with this device in endovascular abdominal aortic aneurysm (AAA) repair. METHODS: From November 1993 to October 1996, 45 patients aged 60 to 86 years underwent endoluminal exclusion of true AAAs (median diameter 60 mm) involving the common iliac arteries (median diameter 16 mm right and 15 mm left) using unilimb stent-grafts deployed with the Iancev-Malmo system. RESULTS: Six immediate conversions occurred in the beginning of the series due to endografts that were too short. Complications, including 2 inadvertent renal artery occlusions, 7 kinked grafts, 6 iliac artery dissections, and 3 perioccluder leaks, were prominent features in the first 15 patients. Five patients died in the postoperative period, four of whom were nonsurgical candidates. There were five significant stent-graft migrations: one 3 weeks after surgery due to mechanical injury of the proximal stent and four after 1 year owing to continuous dilation of a wide proximal neck, stent-graft placement in a conical, thrombus-lined proximal neck, and two instances of proximal extension separation from the main graft. Translumbar aneurysm perfusion required embolization in 3 patients. CONCLUSIONS: Despite early complications associated with a learning curve, exclusion of large AAAs using unilimb stent-grafts is feasible. Strict inclusion criteria are necessary in order to improve mortality among nonsurgical candidates and minimize the risk for late migration.
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| 2. |
- Malina, Martin, et al.
(författare)
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Changing aneurysmal morphology after endovascular grafting: relation to leakage or persistent perfusion
- 1997
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Ingår i: Journal of Endovascular Surgery. - 1074-6218. ; 4:1, s. 23-30
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To relate changing abdominal aortic aneurysm (AAA) morphology after endovascular grafting to the presence of leakage, collateral perfusion, and other factors. METHODS: Thirty-five patients who underwent successful AAA endovascular grafting were evaluated. Self-expanding Z-stents and Dacron grafts were applied in bifurcated and aortomonoiliac systems. Postoperative diameter changes were calculated from repeated spiral computed tomographic scans, angiograms, and ultrasonic phase-locked echo-tracking scans during a median 6-month follow-up (interquartile range [IQR] 3 to 12). RESULTS: At 12 months, the diameters of completely excluded aneurysms had decreased 6 mm (IQR 2 to 11; p = 0.006). The proximal graft-anchoring stents had dilated 2 mm (IQR 0.5 to 3.3; p = 0.01). The aortic diameters immediately below the renal arteries but above the stents had not changed. Endoleakage and collateral perfusion (n = 13) were each associated with preserved aneurysm size and a 12 times higher risk of aneurysm dilation. After the leakage or the collateral perfusion had been treated, the aneurysm size decreased. Aneurysms with extensive intraluminal thrombi presented a reduced risk of leakage or perfusion. CONCLUSIONS: The diameters of endovascularly excluded AAAs decrease, except in cases of leakage or perfusion. Careful follow-up of patients with aortic endografts is necessary.
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| 3. |
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| 4. |
- Chuter, Timothy A M, et al.
(författare)
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A telescopic stent-graft for aortoiliac implantation
- 1997
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Ingår i: European Journal of Vascular and Endovascular Surgery. - 1532-2165. ; 13:1, s. 79-84
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To test a new delivery system for a telescopic stent-graft. MATERIALS: Variable overlap between the components of this stent-graft combination allows length adjustment. This device differs from other multi-component stent-grafts in that both components are contained within a single delivery system. METHODS: The stent-graft was implanted in the distal thoracic to suprarenal aorta of five pigs (35-50 kg), where the arterial diameter falls by almost 50%. The proximal and distal components of the stent-graft were targeted to bony landmarks in the vertebral column. RESULTS: Inspection of completion angiograms showed both proximal and distal stent-grafts to be within 1 mm of their target locations in all five experiments. Overall combined stent-graft length varied from 13.5 cm to 16.1 cm depending on the location of the bony landmark chosen as the distal target, and on the size of the pig. CONCLUSIONS: This system may be useful for the repair of abdominal aortic aneurysm whenever preoperative sizing is difficult due to aortic tortuosity, or precluded due to the urgency of the procedure.
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| 5. |
- Chuter, Timothy A M, et al.
(författare)
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Aneurysm pressure following endovascular exclusion
- 1997
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Ingår i: European Journal of Vascular and Endovascular Surgery. - 1532-2165. ; 13:1, s. 85-87
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To assess the effect of stent-graft implantation on the pressure within an abdominal aortic aneurysm. METHODS: Aneurysm exclusion was performed using an aorto-uniiliac stent-graft in eight patients. Following stent-graft implantation, pressure measurements were performed through a catheter adjacent to the graft in the aneurysm. This "aneurysm pressure" was compared with radial arterial pressure. RESULTS: The pressure was lower in the aneurysm than in the radial artery, in all cases. Mean aneurysm pressure was 36.5/33.8 mmHg, while mean radial arterial pressure was 118.5/50.5 mmHg (p < 0.05, for both systolic and diastolic pressures). These findings corresponded with a reduction in the palpable abdominal pulse, and an absence of perigraft perfusion on follow-up computerised tomography. CONCLUSION: Stent-graft implantation produces a fall in the pressure within an abdominal aortic aneurysm.
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