Iatrogenic injuries of the common femoral artery (CFA) and external iliac artery (EIA) during endograft placement: An underdiagnosed entity (original) (raw)
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Journal of Vascular Surgery, 2002
Objective: Graft limb occlusion may complicate endovascular abdominal aortic aneurysm repair. The precise etiologic factors that contribute to the development of these graft limb thromboses have not been defined. We evaluated our experience with bifurcated aortic endografts to determine factors that may predict subsequent limb thrombosis. The management of the thrombosed limbs and the results after treatment were also investigated. Methods: During a 4-year period, 351 patients with aortic aneurysms underwent treatment with bifurcated endografts (702 graft limbs at risk). These 351 bifurcated devices included AneuRx (Medtronic, Minneapolis, Minn; n ؍ 35), n ؍ 18). Details regarding the type of device, mechanism of deployment, and aortoiliac artery anatomy were collected prospectively and analyzed. Graft limbs were analyzed for diameter, use of additional endograft iliac extensions, deployment in the external iliac artery, and endograft to vessel oversizing. Follow-up included physical examination, duplex ultrasonography, and spiral computed tomographic scans at 1 month, 6 months, and 12 months and annually thereafter. The follow-up period ranged from 2 to 54 months, with a mean follow-up period of 20 months.
The outcome of failed endografts inserted for superficial femoral artery occlusive disease
Journal of Vascular Surgery, 2013
Objective: Endografts represent a relatively new treatment modality for occlusive disease of the superficial femoral artery, with promising results. However, endografts may occlude collateral arteries, which may affect outcome in case of failure. The purpose of this study was to analyze the clinical outcome of failed endografts in patients with superficial femoral artery occlusive disease. Methods: All patients treated with one or more polytetrafluorethylene-covered stents between November 2001 and December 2011 were prospectively included in a database. Patients with a failure of the endograft were retrospectively analyzed. Clinical and hemodynamic parameters were assessed before the initial procedure and at the time of failure. Outcome of secondary procedures was analyzed. Results: Among the 341 patients who were treated during the study period, 49 (14.4%) failed during follow-up. Mean (standard deviation) Rutherford category at failure did not differ from the category as scored before the initial procedure (3.1 [1.3] vs 3.3 [0.6]; P [ .33). Forty-three percent of patients (n [ 21) presented with the same Rutherford category as before the initial procedure, 37% (n [ 18) with an improved category, and 20% (n [ 10) with a deteriorated category. The ankle-brachial index was significantly lower at the time of failure (0.66 [0.19] vs 0.45 [0.19[; P <.002). Seventy-six percent of patients with a failure needed secondary surgery, of which 25% were below knee. The 1-year primary, primaryassisted, and secondary patency rates of secondary bypasses were 55.1%, 62.3%, and 77.7%, respectively. The amputation rate was 4.1% (n [ 2). Conclusions: Failure of endografts is not associated with a deterioration in clinical state and is related to a low amputation rate. The hypothesis that covered stents do not affect options for secondary reconstructions could not be confirmed, as 25% of patients with a failure underwent a below-knee bypass. Secondary surgical bypasses are correlated with poor patency. The amputation rate after failure is low.
Endograft limb occlusion and stenosis after ANCURE endovascular abdominal aneurysm repair
Journal of Vascular Surgery, 2002
Objective: The purpose of this study was to define the incidence and treatment of endograft limb stenosis or occlusion (endograft limb dysfunction [ELD]) in a single center with the ANCURE unsupported bifurcated or aortouniiliac endograft by using intraoperative completion angiography and postoperative color duplex ultrasound scanning (CDU). Methods: Sixty-seven endografts (58 bifurcated, 9 uniiliac) were implanted between February 1996 and July 2000. Intraoperative completion aortography was performed in every patient. Postoperative assessment of the endograft consisted of CDU and computed tomography scanning and kidney, ureter and bladder radiographs within 7 days of implantation, at 3 and 6 months after the operation, and every 6 months thereafter. Results: At the time of endograft implantation, widely patent normal-appearing endograft limbs were revealed by means of the initial completion angiogram in 58 of 67 patients (group 1). ELD subsequently developed in seven of these 58 patients (13.4%). The results of the completion angiogram were not normal in the remaining nine patients (group 2), leading to the deployment of a self-expanding stent within the endograft limbs. The results of subsequent angiography were normal. No ELD has occurred in any patient in group 2 to date. The primary assisted patency rate at 30 months was 88% ± 5.2% for group 1 versus 100% ± 0% for group 2 (P = not significant, Log-rank test).
Annals of vascular surgery, 2015
Endovascular aneurysm repair has become the preferred method to treat abdominal aortic aneurysms (AAAs). The Ovation TriVascular Stent-Graft system introduces a unique concept of separation of the metal (stent) and fabric (graft) portion of the endograft's main body to facilitate delivery through ultra-low profile 14Fr devices. In the setting of a narrow distal aneurysmal lumen -usually due to the presence of thrombus- deployment of this endograft may be complicated by folding and collapse of the (unsupported by a stent) aortic body or limbs, making catheterization and ballooning impossible. We present a case of Ovation endograft contralateral limb collapse in a tight AAA lumen due to thrombus deposition, which led to folding and total occlusion of the limb and made limb catheterization impossible. This is a real-life example of how the external iliac artery-to-internal iliac artery endograft technique may be used as a bailout procedure, converting the procedure into an aorto-un...
Journal of Vascular Surgery, 2003
We evaluated mid-term results of the multicenter EVT/Guidant aortouniiliac endograft (AI) trial and ascertained the durability of this endovascular technique in patients unable to undergo standard bifurcated endografting. Methods: From November 1996 to December 1998, 121 patients were enrolled to receive the AI device on the basis of complex iliac artery anatomy contraindicating bifurcated endografting. Clinical data were centrally collected, and radiographic data were evaluated by core facility.
Irish Journal of Medical Science, 2012
PURPOSE: To assess the time period of onset, etiology, and outcomes of limb occlusion after endovascular repair of abdominal aortic aneurysms with supported endografts. MATERIALS AND METHODS: From 1998 to 2007, 288 patients underwent endovascular aneurysm repair (EVAR) to exclude an infrarenal aortic aneurysm. In the majority of patients, a Zenith stent-graft (n ؍ 187) or Excluder stent-graft (n ؍ 71) was implanted. Nine patients presented with limb occlusion during follow-up. All occluded stent-grafts were modular (n ؍ 8) or aortomonoiliac (n ؍ 1) Zenith endoprostheses. One additional patient who was previously treated with a Zenith aortomonoiliac stent-graft was referred to our institution for further treatment of stent-graft thrombosis. , surgical thrombectomy or bypass operation (n ؍ 5), and expectant management (n ؍ 2). Outcome of all revascularization procedures showed immediate clinical success in all patients and no late recurrent limb ischemia at a mean follow-up of 38.9 months. CONCLUSIONS: Limb occlusion of aortic stent-grafts mostly occurs shortly after EVAR and can be related to underlying kinking of the metallic skeleton, extension of the stent-graft into the external iliac artery, or migration and dislocation of an endograft limb. Satisfactory and durable clinical outcomes can be obtained after appropriate revascularization.
Failure of endovascular abdominal aortic aneurysm graft limbs
Journal of Vascular Surgery, 2001
Objective: Endovascular abdominal aortic aneurysm (AAA) grafts are subject to subsequent failure of endograft limbs. We sought to determine what device-related factors could be identified that might contribute to limb failure. Methods: We reviewed the records of patients who had undergone endovascular AAA repair and femorofemoral bypass grafting at a single institution. Results: Endovascular AAA repair was performed in 173 patients. There were 137 bifurcated endografts and 36 aortomonoiliac grafts combined with femorofemoral bypass grafts, yielding a total population of 310 aortic graft limbs and 36 femorofemoral grafts. Thirty-nine additional patients underwent femorofemoral bypass grafting for occlusive disease. The cumulative primary patency of all endografts performed for AAA was 92% at 21 months. Secondary patency was achieved for all failed endograft limbs. There were 24 aortic graft limb "failures" that required intervention: seven limbs underwent thrombosis requiring revision; kinked limbs requiring stenting either at the time of graft placement (17) or subsequently (7) were identified. Fully supported endograft limbs had better primary patency (97% at 18 months) than unsupported limbs (69% at 18 months, P < .001). The aortomonoiliac grafts with femorofemoral bypass grafts tended to have better patency (97% at 18 months) than bifurcated endografts (90% at 18 months), but this did not reach statistical significance (P = .28, not significant). Femorofemoral grafts performed for occlusive disease were found to have somewhat lower patency than those performed for AAA (83% vs 92% at 18 months of follow-up, P = .37, not significant). Conclusions: Fully supported AAA endografts provide superior endograft limb patency compared with unsupported designs. Consideration should be given to routine stenting of all unsupported endograft limbs. Aortomonoiliac grafts and bifurcated grafts provide similar results for endograft limb patency. Femorofemoral bypass grafts performed in conjunction with aortomonoiliac grafts for AAA disease provide excellent short-term patency. (J Vasc Surg 2001;33:296-303.)
Annals of Vascular Surgery, 2018
Aim: Bilateral limb occlusion after endovascular aortic repair (EVAR) is relatively uncommon. The aim of this study was to investigate the incidence of bilateral endograft limb occlusion after EVAR and identify potential anatomical predictive factors of occurrence. Materials-Methods: A total of 579 patients underwent elective EVAR for abdominal aortic aneurysm (AAA) between January 2010 and December 2015. All patients presenting with unilateral and bilateral occlusion were prospectively analyzed. A group of patients who underwent EVAR, but did not present with endograft limb occlusion were matched for sex, age, and commercial type of endograft and were used as controls. Results: Overall, 21 (3.6%) patients were complicated with unilateral endograft limb occlusion, whereas 8 (1.4%) of them presented with sequential (in different time) bilateral limb occlusion. We found that iliac artery angulation ≥ 60˚, iliac perimeter calcification ≥ 50% and endograft oversizing in the common iliac artery of more than 15%, had the same impact and could equally result in limb occlusion. We coded the variables angle, calcification and endograft limb oversizing of the common iliac artery with a score from 0 to 2 as follows: a
Less Invasive (Common) Femoral Artery Aneurysm Repair Using Endografts and Limited Dissection
European Journal of Vascular and Endovascular Surgery, 2013
WHAT THIS PAPER ADDS A hybrid endovascular/open surgical technique, using an endograft connector to simplify anastomoses, is presented for the treatment of true and selected false aneurysms of the common femoral artery. This technique is especially useful when there is proximal extension to involve the external iliac artery. This procedure can be performed under local anaesthesia with sedation. It avoids extensive circumferential arterial dissection and cross-clamping as well as the need for retroperitoneal or transperitoneal exposure. Treatment is thereby simplified and complications reduced.