REFERENCES

COMMENTS?

 

 
References on Aortic Stent Graft for Abdominal Aortic Aneurysm

*****AJR.  AMERICAN JOURNAL OF ROENTGENOLOGY*****

(REFERENCE 1 OF 20)
20163565

Gorich J  Rilinger N  Kramer S 
  Sokiranski R  Pamler R  Ermis C 
  Kapfer X 
Angiography of leaks after endovascular repair of infrarenal aortic
  aneurysms.

In: AJR Am J Roentgenol (2000 Mar) 174(3):811-4

ISSN: 0361-803X

OBJECTIVE: We examined whether leaks that persist after stent
  grafting are associated with outflow arteries. SUBJECTS AND METHODS:
  Selective angiography was performed in 21 patients with persistent
  leaks after undergoing endovascular repair of infrarenal aneurysms of
  the abdominal aorta. Late leaks occurred in five patients whose
  prostheses were originally sealed. Before angiography, the size and
  position of leaks were determined with CT and color Doppler
  sonography. RESULTS: Superselective angiography was successful in 19
  of 21 patients. In two patients, angiography was performed over the
  afferent artery supplying the leak. We found one outflow artery at
  the site of the leak in 10 patients (47%); two outflow arteries in
  five (23.8%); and as many as five outflow arteries in three (14%).
  Angiography overlooked outflow arteries in three patients (14%). The
  lumbar and inferior mesenteric, urethral, and testicular arteries
  were identified as outflow arteries. CONCLUSION: Other than feeder
  arteries, persistent leaks are associated with outflow vessels that
  contribute to the patency of leaks.

Institutional address:
     Department of Radiology
     University of Ulm
     Germany.

(REFERENCE 2 OF 20)
96072702

Rozenblit A  Marin ML  Veith FJ 
  Cynamon J  Wahl SI  Bakal CW 
Endovascular repair of abdominal aortic aneurysm: value of
  postoperative follow-up with helical CT.

In: AJR Am J Roentgenol (1995 Dec) 165(6):1473-9

ISSN: 0361-803X

OBJECTIVE. Transfemorally placed endoluminal grafts are currently
  being evaluated as an alternative to open surgery for the treatment
  of abdominal aortic aneurysms. We determined the value of helical CT
  for the follow-up of patients treated with this new procedure. The
  purposes of this study were to determine CT features of a technically
  successful procedure, detect complications, and compare findings on
  CT scans obtained 24-48 hr after insertion of the graft with findings
  on angiograms obtained at the end of the endovascular procedure.
  SUBJECTS AND METHODS. Seven patients with large abdominal aortic
  aneurysms had helical CT within 48 hr after transfemoral insertion of
  an endoluminal graft. Findings on these CT scans were compared with
  findings on digital completion angiograms obtained immediately after
  placement of the graft. Additional follow-up CT scans were obtained
  for up to 15 months (mean, 8 months). The size of the aneurysmal sac;
  completeness of perigraft thrombosis; and position, shape, and
  patency of the device were recorded. RESULTS. CT scans obtained 24-48
  hr after placement of the grafts showed complete thrombosis of the
  aneurysmal sac in three patients and incomplete thrombosis with
  patent perigraft channels in the four remaining patients. Angiograms
  showed a patent perigraft channel in only one patient. Two of four
  initially patent channels subsequently closed, but one of them
  recurred. Of four thrombosed aneurysms, two decreased in size, and
  two were unchanged on later follow-up. Of three aneurysms associated
  with perigraft channels, two became enlarged and one was stable. On
  the basis of CT criteria, successful endovascular repair was shown in
  four (57%) of seven patients. CONCLUSION. Helical CT is a sensitive
  means of evaluating the efficacy of endoluminal grafts. Decreased or
  stable size of the aneurysmal sac without perigraft channels on late
  follow-up CT signifies technical success. Persistence or recurrence
  of perigraft channels is the most likely cause of later enlargement
  of an aneurysm and therefore suggests procedural failure. Helical CT
  was more sensitive than angiography for detection of perigraft
  channels that occurred soon after treatment.

Institutional address:
     Department of Radiology
     Montefiore Medical Center
     Albert Einstein College of Medicine
     Bronx
     NY 10467
     USA.


*****AMERICAN JOURNAL OF SURGERY*****

(REFERENCE 3 OF 20)
99123983

Allen BT  Hovsepian DM  Reilly JM 
  Rubin BG  Malden E  Keller CA 
  Picus DD  Sicard GA 
Endovascular stent grafts for aneurysmal and occlusive vascular
  disease.

In: Am J Surg (1998 Dec) 176(6):574-80

ISSN: 0002-9610

BACKGROUND: This report details our initial experience with two types
  of endovascular grafts- one for the treatment of infrarenal abdominal
  aortic aneurysms and the other for the treatment of iliac artery
  occlusive disease. METHODS: An abdominal aortic aneurysm was repaired
  in 34 patients using 3 different types of Ancure endografts (Menlo
  Park, California). Control patients (n = 9) had a standard aneurysm
  repair. Patients with chronic lower extremity ischemia (n = 7)
  secondary to iliac artery occlusive disease were treated with a
  Hemobahn endograft (W. L. Gore & Associates, Flagstaff, Arizona).
  RESULTS: Ancure graft deployment was achieved in 33 of 34 (97.1%)
  patients. Perioperative mortality for the Ancure and control group
  patients was 2.9% and 0%, respectively. Periprosthetic leaks were
  identified within 48 hours of deployment in 6 (18.2%) Ancure graft
  patients. All but 2 of the leaks resolved on serial follow-up.
  Additional endovascular procedures were required in 11 (32.4%) Ancure
  graft patients at the initial procedure or during follow-up to
  correct graft or arterial stenoses. Patients treated with an
  endovascular graft had significantly less blood loss and shorter
  hospital stays than control group patients. For Hemobahn patients,
  the technical success for graft deployment was 100%. There were no
  perioperative deaths. The ankle/brachial index increased from a mean
  of 0.52 preoperatively to 0.86 postoperatively (P = 0.004). One
  patient required a Wallstent in follow-up to correct a graft wrinkle.
  Angiography at 6 months demonstrated mild intimal hyperplasia in the
  stent graft in 5 of 6 patients. CONCLUSIONS: These early results
  support the potential for endovascular grafts in the treatment of
  aneurysmal and occlusive vascular disease. Further modifications in
  the devices and deployment techniques are necessary to reduce the
  incidence of periprosthetic leaks, graft limb stenoses, and intimal
  hyperplasia.

Institutional address:
     Sections of Vascular Surgery
     Washington University School of Medicine
     St. Louis
     Missouri
     USA.


*****BRITISH JOURNAL OF RADIOLOGY*****

(REFERENCE 4 OF 20)
97116947

Dyet JF 
Pictorial review: endovascular repair of abdominal aortic aneurysms.

In: Br J Radiol (1996 Nov) 69(827):1069-74

ISSN: 0007-1285

Endovascular repair of abdominal aortic aneurysms is an exciting new
  procedure. Depending on aneurysm morphology, tube grafts, bifurcated
  grafts or aorto-uni-iliac systems may be used. Early results are
  encouraging but many problems will require solving before the
  technique comes into general use.

Institutional address:
     Department of Radiology
     Hull Royal Infirmary
     UK.


*****EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY*****

(REFERENCE 5 OF 20)
99307532

Cuypers P  Buth J  Harris PL  Gevers E 
  Lahey R 
Realistic expectations for patients with stent-graft treatment of
  abdominal aortic aneurysms. Results of a European multicentre
  registry.

In: Eur J Vasc Endovasc Surg (1999 Jun) 17(6):507-16

ISSN: 1078-5884

OBJECTIVE: the outcomes for patients after endovascular treatment of
  abdominal aortic aneurysm (AAA) are determined primarily by the
  endpoints of death and endoleaks, the latter representing continued
  risk of rupture. The data of a multicentre registry were analysed
  with regard to the early outcome of stent-graft procedures for AAA
  and the complications associated with this treatment. In addition,
  the results during follow-up were analysed by determining mortality
  and endoleak development as separate endpoints and as a combined
  endpoint defined as endoleak-free survival. SETTING: 38 European
  institutions of Vascular Surgery collaborating in a multicentre
  registry project. PATIENTS AND METHODS: 899 patients with AAA
  underwent between May 1994 and March 1998 elective endovascular
  repair (818 men and 81 women; mean age 69 years). 80 (8.9%) of the
  patients had medical conditions that excluded them from open repair.
  818 (91%) of patients had a bifurcated device, 63 (7%) had a straight
  tube graft, and only 18 (2%) had an aorto-uni-iliac device. Clinical
  examination and contrast-enhanced computed tomography was performed
  at fixed follow-up intervals to assess increase or decrease of the
  maximum transverse diameter (MTD). Endoleaks observed at follow-up
  were discriminated into persistent endoleak and temporary endoleak.
  The latter is defined as single time observed endoleaks or with two
  or more negative imaging studies between observed endoleaks. Life-
  table analyses were used to calculate the rates of freedom-from-
  endoleak (no endoleak at any time), freedom-from-persistent endoleak
  (no persistent endoleak), patient survival, and persistent-endoleak-
  free-survival. RESULTS: the median follow-up of this patient series
  was 6.2 months. The ratio between observed and expected follow-up
  data was 82% for the overall follow-up period. However, at 18 months
  of follow-up this rate was only 45%. The number of patients followed
  during this period was sufficient to allow statistically meaningful
  assessment. The MTD in patients with temporary endoleaks demonstrated
  a significant decrease at 6 to 12 months compared to preoperative
  values (mean 57 and 53 respectively, p =0.004). In patients with
  persistent endoleaks there was no change between the preoperative and
  6-month MTD (mean 57 and 60 mm respectively). At 6 and 18 months
  freedom-from-endoleak was 83% and 74% and freedom-from-persistent
  endoleak was 93% and 90%, respectively. The 18-month cumulative
  patient survival was 88% and the main outcome measure, the persistent
  endoleak-free-survival was 79%. CONCLUSIONS: the MTD decreases in
  patients with temporary endoleak, but not in patients with persistent
  endoleak. Therefore, the use of the rate of freedom-from-persistent
  endoleak, reflecting absence of persisting endoleaks to estimate the
  prognosis with regard to the AAA, is justified. Determining
  persistent endoleak-free survival appears a rational approach to
  provide a realistic outlook for patients with stent-grafted AAA. The
  observed 18-month endoleak-free survival reflects a satisfactory mid-
  term result. Copyright 1999 W.B. Saunders Company Ltd.

Institutional address:
     EUROSTAR Data Registry Centre
     Department of Vascular Surgery
     Eindhoven
     The Netherlands.


*****JOURNAL OF VASCULAR SURGERY*****

(REFERENCE 6 OF 20)
20414655

Wolf YG  Fogarty TJ  Olcott C IV 
  Hill BB  Harris EJ  Mitchell RS 
  Miller DC  Dalman RL  Zarins CK 
Endovascular repair of abdominal aortic aneurysms: eligibility rate
  and impact on the rate of open repair.

In: J Vasc Surg (2000 Sep) 32(3):519-23

ISSN: 0741-5214

OBJECTIVE: The purpose of this study was to determine the rate of
  eligibility among patients with abdominal aortic aneurysms (AAAs)
  considered for endovascular repair and to examine the effect of an
  endovascular program on the institutional pattern of AAA repair.
  METHODS: All patients evaluated for endovascular AAA repair since the
  inception of an endovascular program were reviewed for determination
  of eligibility rates and eventual treatment. Open AAA repairs were
  categorized as simple (uncomplicated infrarenal), complex
  (juxtarenal, suprarenal, thoracoabdominal, infected), or ruptured,
  and their rates before and after initiation of an endovascular
  program were compared. RESULTS: Over 3 years, 324 patients were
  considered for endovascular AAA repair; 176 (54%) were candidates,
  138 (43%) were not candidates, and 10 (3%) did not complete the
  evaluation. The rate of eligibility increased significantly from 45%
  (66/148 patients) during the first half of this period to 63%
  (110/176 patients) during the second half (P <. 001). Candidates were
  significantly younger (74.4 +/- 7.6 years) than noncandidates (78.3
  +/- 6.7 years) (P <.01), and their aneurysm diameter tended to be
  smaller (57.6 +/- 9.2 mm compared with 60.8 +/- 12.3 mm; P =.06). The
  most common reason for ineligibility was an inadequate proximal
  aortic neck. Of 176 candidates, 78% underwent endovascular repair,
  and 6% underwent open repair. Of 138 noncandidates, 56% underwent
  surgical repair. Over a period of 6 years, 542 patients with AAAs
  (429 simple, 86 complex, 27 ruptured) underwent open repair. The
  total number and ratio of simple to complex open repairs for
  nonruptured aneurysms during the 3 years before the initiation of the
  endovascular program (213 simple, 44 complex) were not significantly
  different from the repairs over the subsequent 3-year period (216
  simple, 42 complex). Similarly, no difference in the total number and
  the ratio of simple to complex open repairs was found between the
  first and the second 18-month periods since the initiation of the
  endovascular program. CONCLUSIONS: The rate of eligibility of
  patients with AAA for endovascular repair appears to be higher than
  previously reported. The presence of an active endovascular program
  has not decreased the number or shifted the distribution of open AAA
  repair.

Institutional address:
     Division of Vascular Surgery
     Stanford University Medical Center
     Stanford
     CA
     USA.

(REFERENCE 7 OF 20)
20302956

Kalliafas S  Albertini JN  Macierewicz J 
  Yusuf SW  Whitaker SC  Macsweeney ST 
  Wenham PW  Hopkinson BR 
Incidence and treatment of intraoperative technical problems during
  endovascular repair of complex abdominal aortic aneurysms.

In: J Vasc Surg (2000 Jun) 31(6):1185-92

ISSN: 0741-5214

PURPOSE: The purpose of this study was to assess the incidence and
  management of intraoperative technical problems during endovascular
  repair (EVR) of complex abdominal aortic aneurysms (AAA). METHODS:
  From February 1995 to March 1999, 204 EVRs of nonruptured AAA were
  performed at our institution. One hundred seventy-six patients had an
  in-house custom-made graft; 172 were aorto-uni-iliac grafts, and four
  were aortoaortic grafts. Twenty- eight patients had a bifurcated
  graft. One hundred fourteen patients (56%) were high risk for
  conventional open repair. One hundred nine patients (53%) were not
  suitable for most commercially available devices. RESULTS:
  Intraoperative technical problems occurred in 81 patients (40%).
  There were 37 endoleaks (27 proximal, 10 distal), 15 graft stenoses,
  one failure of graft deployment, two graft thromboses, three
  aortoiliac ruptures, five renal artery occlusions (one bilateral,
  four unilateral), and 18 internal iliac occlusions (five bilateral,
  13 unilateral). Endovascular management of these problems was
  successful in 37 of the 81 patients (46%) and included 15 balloon
  dilatations, 21 additional stent placements, and one graft
  thrombectomy. Fifteen of the 81 patients (19%) had open procedures
  (four periaortic ligature placements, six open aneurysm repairs,
  three common iliac ligations, and two extra-anatomic bypass grafts).
  In the remaining 29 patients, the on-table problem was managed
  expectantly. During follow-up, two of 37 patients (5%) who were
  treated successfully with endovascular procedures experienced
  recurrence. There were five deaths (33%) among the 15 patients who
  underwent open procedures. CONCLUSION: Intraoperative problems occur
  frequently during the endovascular management of complex aneurysms.
  Many of these problems can be managed with additional endovascular
  techniques without an increased risk of recurrence or procedure-
  related complications. Open procedures in high-risk patients carry a
  high mortality rate. The team performing EVR of AAA should be
  skillful in advanced endovascular and open surgical procedures.

Institutional address:
     Division of Vascular Surgery
     Nottingham University Hospital
     United Kingdom.

(REFERENCE 8 OF 20)
20111341

Chuter TA  Reilly LM  Faruqi RM 
  Kerlan RB  Sawhney R  Canto CJ 
  LaBerge JM  Wilson MW  Gordon RL 
  Wall SD  Rapp J  Messina LM 
Endovascular aneurysm repair in high-risk patients.

In: J Vasc Surg (2000 Jan) 31(1 Pt 1):122-33

ISSN: 0741-5214

PURPOSE: The purpose of this study was to evaluate the role of
  endovascular aneurysm repair in high-risk patients. METHODS: The
  elective endovascular repair of infrarenal aortic aneurysm was
  performed in 116 high-risk patients with either custom-made or
  commercial stent grafts. The routine follow-up examination included
  contrast-enhanced computed tomography (CT) before discharge, at 3, 6,
  and 12 months, and annually thereafter. Patients with endoleak on the
  initial CT underwent re-evaluation at 2 weeks. Those patients with
  positive CT results at 2 weeks underwent endovascular treatment.
  RESULTS: Endovascular repair was considered feasible in 67% of the
  patients. The mean age was 75 years, and the mean aneurysm diameter
  was 6.3 cm. The American Society of Anesthesiologists grade was II in
  3.4%, III in 65.5%, IV in 30.1%, and V in 0.9%. There were no
  conversions to open repair. Custom-made aortomonoiliac stent grafts
  were implanted in 77.6% of the cases, custom-made aortoaotic stent
  grafts in 11.2%, and commercial bifurcated stent grafts in 11.2%. The
  30-day rates of mortality, major morbidity, and minor morbidity were
  3.4%, 20.7%, and 12%, respectively, in the first 58 patients and 0%,
  3.4%, and 3.4%, respectively, in the last 58. The late complications
  included five cases of stent graft kinking, two cases of
  femorofemoral graft occlusion, and three cases of proximal stent
  migration, one of which led to aneurysm rupture. At 2 weeks after
  repair, endoleak was present in 10.3% of the cases. All the type I
  (direct perigraft) endoleaks underwent successful endovascular
  treatment, whereas only one type II (collateral) endoleak responded
  to treatment. The technical success rate at 2 weeks was 86.2%, and
  the clinical success rate was 96.6%. The continuing success rate was
  87.9%. Seventeen patients died late, unrelated deaths. CONCLUSION:
  Endovascular aneurysm repair is safe and effective in patients at
  high risk, for whom it may be the preferred method of treatment.

Institutional address:
     Divisions of Vascular Surgery
     University of California-San Francisco
     CA 94143
     USA.

(REFERENCE 9 OF 20)
99137869

Zarins CK  White RA  Schwarten D 
  Kinney E  Diethrich EB  Hodgson KJ 
  Fogarty TJ 
AneuRx stent graft versus open surgical repair of abdominal aortic
  aneurysms: multicenter prospective clinical trial.

In: J Vasc Surg (1999 Feb) 29(2):292-305; discussion 306-8

ISSN: 0741-5214

The results of a prospective, nonrandomized, multicenter clinical
  trial that compared endovascular stent graft exclusion of abdominal
  aortic aneurysms with open surgical repair are presented. During an
  18-month period, 250 patients with infrarenal aneurysms underwent
  treatment at 12 study sites-190 patients underwent endovascular
  repair using the Medtronic AneuRx stent graft (Sunnyvale, Calif), and
  60 underwent open surgical repair. There was no significant
  difference in operative mortality rates between the groups. The
  patients who underwent stent grafting had significant reductions in
  blood loss, time to extubation, and days in the intensive care unit
  and in the hospital, with an earlier return to function. The major
  morbidity rate was reduced from 23% in the surgery group to 12% (P <.
  05) in the stent graft group. There was no difference in the combined
  morbidity/mortality rates between the two groups. Primary technical
  success at the time of discharge for the patients with stent grafts
  was 77%, largely as a result of a 21% endoleak rate. At 1 month, the
  endoleak rate had decreased to 9%. There was no difference in the
  primary or secondary procedure success rates at 30 days between the
  surgery and stent graft groups. The primary graft patency rate at 6
  months was 98% in the surgery group and 97% in the stent graft group.
  The aneurysm exclusion rate at 1 month and 6 months was 100% in
  patients who underwent surgery and 91% in patients who underwent
  stent grafting. Stent graft migration occurred in three patients and
  resulted in late endoleaks; each endoleak was corrected by means of
  endovascular placement of a stent graft extender cuff. There have
  been no aneurysm ruptures and no surgical conversions to open repair
  in the stent graft group. Stent graft repair compares favorably with
  open surgical repair, with a reduced morbidity rate, shortened
  hospital stays, and satisfactory short term outcomes.

Institutional address:
     Division of Vascular Surgery
     Stanford University Medical Center
     California
     USA.


*****LANCET*****

(REFERENCE 10 OF 20)
20475772

Laheij RJ  van Marrewijk CJ 
Endovascular stenting of abdominal aortic aneurysm in patients unfit
  for elective open surgery. Eurostar group. EUROpean collaborators
  registry on Stent-graft Techniques for abdominal aortic Aneurysm
  Repair

In: Lancet (2000 Sep 2) 356(9232):832

ISSN: 0140-6736

Endovascular aneurysm repair is useful for patients who are judged
  unfit for surgery. We investigated the outcome of endovascular repair
  of abdominal aortic aneurysm in patients fit and unfit for surgery.
  The 1-year cumulative survival for patients unfit for surgery and
  patients unfit for general anaesthesia was 20% and 23%, respectively.
  The overall health status of patients was an important predictor of
  survival after endovascular repair. The risks of endovascular
  aneurysm repair might, therefore, exceed that of non-operative
  management. Caution should be used when advising these patients about
  endovascular repair.


*****MAYO CLINIC PROCEEDINGS*****

(REFERENCE 11 OF 20)
20224561

Hallett JW Jr 
Management of abdominal aortic aneurysms.

In: Mayo Clin Proc (2000 Apr) 75(4):395-9

ISSN: 0025-6196

Rupture of an abdominal aortic aneurysm (AAA) remains a common
  vascular catastrophe in all emergency departments. Currently, the
  natural history of AAAs indicates that risk of rupture increases
  considerably when the aneurysm is greater than 5 cm in diameter.
  Appropriate management of aneurysms is elective repair for patients
  with a good operative risk whose aneurysm is between 5 and 6 cm. For
  patients with a serious medical comorbidity, the threshold for AAA
  repair is usually 6 cm. Surgical management is generally safe with
  extraordinarily durable results. Another current option is an
  investigational endovascular stent graft, but the long-term outcome
  for these new devices remains unknown. In addition, optimal medical
  management should include careful control of hypertension and smoking
  cessation. The current prognosis for healthy patients who undergo
  elective aneurysm repair is excellent.

Institutional address:
     Division of Vascular Surgery
     Mayo Clinic Rochester
     Minn. 55905
     USA.

(REFERENCE 12 OF 20)
20375438

Seelig MH  Oldenburg WA  Hakaim AG 
  Hallett JW  Chowla A  Andrews JC 
  Cherry KJ 
Endovascular repair of abdominal aortic aneurysms: where do we stand?

In: Mayo Clin Proc (1999 Oct) 74(10):999-1010

ISSN: 0025-6196

Endovascular repair of abdominal aortic aneurysms has evolved
  dramatically within the past few years. In light of the potential to
  reduce morbidity and mortality associated with open surgical repair,
  endoluminal grafting offers therapeutic options to patients who are
  not surgical candidates because of comorbidities. With the
  development of bifurcated devices, more complex aneurysms may be
  treated by endovascular grafting. Although successful placement of
  endovascular grafts requires a pronounced learning curve, including
  appropriate patient selection, midterm results seem consistent with
  those of traditional open repair of aneurysms. This review describes
  the current indications, minimal requirements, different devices and
  associated techniques, and potential complications of endoluminal
  repair of abdominal aortic aneurysms. Future aspects of endoluminal
  grafting are also discussed.

Institutional address:
     Department of Surgery
     Mayo Clinic Jacksonville
     FL 32224
     USA.


*****NEW ENGLAND JOURNAL OF MEDICINE*****

(REFERENCE 13 OF 20)
97122457

Blum U  Voshage G  Lammer J  Beyersdorf F 
  Tollner D  Kretschmer G  Spillner G 
  Polterauer P  Nagel G  Holzenbein T 
  Thurnher S  Langer M 
Endoluminal stent-grafts for infrarenal abdominal aortic aneurysms
  [see comments]

In: N Engl J Med (1997 Jan 2) 336(1):13-20

ISSN: 0028-4793

BACKGROUND: The treatment of aortic aneurysms with endovascular
  stents or stent-graft prostheses is receiving increasing attention as
  an alternative to major abdominal surgery. To define the clinical
  value of this technique, we prospectively studied the use of stent-
  graft endoprostheses made of nitinol and covered with polyester
  fabric for the treatment of infrarenal abdominal aortic aneurysms.
  METHODS: We treated a total of 154 patients at three academic
  hospitals. Twenty-one patients with aortic aneurysms not involving
  the aortic bifurcation received straight stent-grafts, and 133
  patients with aortic aneurysms involving the bifurcation and the
  common iliac arteries received bifurcated stent-grafts. After a
  unilateral surgical arteriotomy, the endoprostheses were advanced
  through the femoral arteries and placed under fluoroscopic guidance.
  Computed tomography and intraarterial angiography were performed
  during an average follow-up of 12.5 months. RESULTS: The primary
  success rate, defined as complete exclusion of the abdominal aortic
  aneurysm from the circulation, was 86 percent in the group receiving
  straight grafts and 87 percent in the group receiving bifurcated
  grafts. In three patients the procedure had to be converted to an
  open surgical operation. Minor (n=13) or major (n=3) complications
  associated with the procedure (including 1 death) occurred in 10
  percent of the patients. All patients had a postimplantation
  syndrome, with leukocytosis and elevated C-reactive protein levels.
  CONCLUSIONS: Our results suggest that endovascular treatment of
  infrarenal abdominal aortic aneurysms is technically feasible and can
  effectively exclude abdominal aortic aneurysms from the circulation.
  With further refinement, endoluminal repair may emerge as an
  interventional strategy to treat infrarenal aortic aneurysms,
  especially in patients at high surgical risk.

Comment in: N Engl J Med 1997 Jan 2;336(1):59-60

Comment in: N Engl J Med 1997 Jun 12;336(24):1756; discussion 1757

Registry Numbers: 52013-44-2 (nitinol)

Institutional address:
     Department of Diagnostic Radiology
     University Hospital
     Freiburg
     Germany.


*****RADIOLOGY*****

(REFERENCE 14 OF 20)
20217183

Armerding MD  Rubin GD  Beaulieu CF 
  Slonim SM  Olcott EW  Samuels SL 
  Jorgensen MJ  Semba CP  Jeffrey RB Jr 
  Dake MD 
Aortic aneurysmal disease: assessment of stent-graft treatment-CT
  versus conventional angiography.

In: Radiology (2000 Apr) 215(1):138-46

ISSN: 0033-8419

PURPOSE: To compare computed tomographic (CT) angiography and
  conventional angiography for determining the success of endoluminal
  stent-graft treatment of aortic aneurysms. MATERIALS AND METHODS:
  Forty patients underwent conventional angiography and CT angiography
  following treatment of aortoiliac aneurysms with endoluminal stent-
  grafts. Six additional sets of conventional angiographic-CT
  angiographic examinations were performed in five patients after
  placement of additional stent-grafts or coil embolization to treat
  perigraft leakage. Three faculty CT radiologists who were blinded to
  patient clinical data and outcome independently interpreted the CT
  angiograms, and three faculty angiographers, who were not involved in
  the stent-graft deployment, interpreted the conventional angiograms.
  Images were assessed for the presence of postdeployment
  complications. A reference standard was developed by experienced
  radiologists using all available images and clinical data.
  Sensitivities, specificities, and kappa values were calculated.
  RESULTS: Perigraft leakage was the most commonly identified
  complication. Twenty perigraft leaks were detected in the results of
  46 examinations. Sensitivities and specificities for detecting
  perigraft leakage were 63% and 77% for conventional angiography and
  92% and 90% for CT angiography, respectively. The kappa value was 0.
  41 for conventional angiography and 0.81 for CT angiography.
  CONCLUSION: CT angiography is the preferred method for establishing
  the presence of perigraft leakage following treatment of aortoiliac
  aneurysms with stent-grafts.

Institutional address:
     Department of Radiology
     Stanford University School of Medicine
     Stanford University Medical Center
     Stanford
     CA 94305-5105
     USA.

(REFERENCE 15 OF 20)
20056725

Gorich J  Rilinger N  Sokiranski R 
  Orend KH  Ermis C  Kramer SC 
  Brambs HJ  Sunder-Plassmann L 
  Pamler R 
Leakages after endovascular repair of aortic aneurysms:
  classification based on findings at CT, angiography, and radiography.

In: Radiology (1999 Dec) 213(3):767-72

ISSN: 0033-8419

PURPOSE: To ascertain whether the configuration and location of
  leakages identified at computed tomography (CT) could provide
  evidence of their angiographically and fluoroscopically confirmed
  causes. MATERIALS AND METHODS: Fifty patients aged 26-79 years
  underwent endovascular repair of traumatic (n = 4) or
  arteriosclerotic (n = 46) aortic aneurysms (four thoracic, 46
  infrarenal). Radiographic examinations in three planes and helical CT
  were performed 1 week after implantation and every 3 months
  thereafter. Angiography was performed when there was evidence of a
  leakage at CT. RESULTS: CT demonstrated evidence of leakages in 13
  patients. Broad-based leakages immediately adjacent to the prosthesis
  were termed "perigraft leakages." If the area most affected by the
  leakage lay along the border of the aneurysm, then retrograde
  leakages were apparent at angiography. If the leakage was ventral to
  the prosthesis, then its source was the inferior mesenteric artery;
  if it was dorsolateral, then it was supplied by either the lumbar
  arteries or the median sacral artery through the hypogastric artery.
  One circumferential leakage could not be evaluated adequately at CT
  or angiography. Radiography depicted a rupture of the stent mesh in
  the middle of the prosthesis. Selective angiography demonstrated all
  types of leakages and permitted CT classification. CONCLUSION: The
  cause of a leakage can be determined with CT on the basis of its
  configuration and location in the majority of cases.

Institutional address:
     Department of Radiology
     University of Ulm
     Germany. petra.silber@medizin.uni-ulm.de

(REFERENCE 16 OF 20)
99223822

Chuter TA  Gordon RL  Reilly LM 
  Kerlan RK  Sawhney R  Jean-Claude J 
  Canto CJ  LaBerge JM  Ring EJ 
  Wall SD  Messina LM 
Abdominal aortic aneurysm in high-risk patients: short- to
  intermediate-term results of endovascular repair.

In: Radiology (1999 Feb) 210(2):361-5

ISSN: 0033-8419

PURPOSE: To assess the safety and efficacy of endovascular repair of
  abdominal aortic aneurysm in high-risk patients during the short to
  intermediate term. MATERIALS AND METHODS: Endovascular aneurysm
  repair was performed in 50 patients considered too high risk for
  conventional repair. Stent-grafts were inserted through surgically
  exposed femoral arteries with fluoroscopic guidance. The anesthetic
  technique was epidural in 36 patients, general in 12, and local in
  two. Aortouniiliac stent-grafts were inserted in 42 patients and
  aortoaortic in eight. RESULTS: There were no deaths and no
  conversions to open surgical repair. The primary success rate
  (complete aneurysm exclusion according to CT criteria) was 88% (44 of
  50). The secondary, clinical, and continuing success rates were all
  98% (49 of 50). Surgical time was 196 minutes +/- 67 (mean +/- SD),
  blood loss was 284 mL +/- 386, and volume of contrast material
  administered was 153 mL +/- 64. The time from the end of the surgery
  to resumption of a normal diet was 0.58 days +/- 0.56, to ambulation
  was 1.22 days +/- 0.77, and to discharge from the hospital was 3.63
  days +/- 1.60. Wound problems accounted for the majority of
  complications. There were no instances of pulmonary failure, renal
  failure, stent-graft migration, or late leakage. CONCLUSION:
  Endovascular repair of abdominal aortic aneurysm is feasible in two-
  thirds of high-risk patients, with a low mortality and high success
  rate during the short to intermediate term.

Institutional address:
     Department of Surgery
     University of California
     San Francisco 94143
     USA.

(REFERENCE 17 OF 20)
98441956

Silberzweig JE  Marin ML  Hollier LH 
  Mitty HA  Parsons RE  Cooper JM 
  Ahn J 
Aortoiliac aneurysms: endoluminal repair--clinical evidence for a
  fully supported stent-graft.

In: Radiology (1998 Oct) 209(1):111-6

ISSN: 0033-8419

PURPOSE: To evaluate aortoiliac aneurysms repaired with endovascular
  stent-grafts complicated by hemodynamically significant graft
  stenosis. MATERIALS AND METHODS: Fifty-four patients (52 men, two
  women; age range, 41-90 years; mean age, 75 years) with aneurysms of
  the infrarenal aorta (n = 36) or iliac artery (n = 18) underwent
  repair by means of placement of an endovascular stent-graft.
  Technical success was evaluated angiographically during and after
  placement. At follow-up (range, 12-44 months), all patients underwent
  sequential duplex ultrasonography, helical computed tomography, and
  physical examination. RESULTS: Stent-grafts were placed successfully
  in all cases. Stenosis at the internal iliac arterial origin was
  identified at angiography in 17 patients (31%). Supplemental
  intragraft stents were placed in 11 patients, and stent-graft
  angioplasty alone was performed in one patient. Intragraft stents
  were placed percutaneously in five patients when stenosis was
  discovered during follow-up. CONCLUSION: Supplemental intragraft
  stents were required in 31% of aortoiliac endovascular stent-grafts
  to correct stent-graft stenosis and preserve long-term function.
  Placement of a fully supported stent-graft is necessary to repair an
  aortoiliac aneurysm.

Registry Numbers: 9002-84-0 (Polytetrafluoroethylene)

Institutional address:
     Department of Radiology
     Mount Sinai Medical Center
     New York
     NY
     USA.

(REFERENCE 18 OF 20)
98085730

Duda SH  Raygrotzki S  Wiskirchen J 
  Khalighi K  Schott U  Bares R 
  Ziemer G  Claussen CD 
Abdominal aortic aneurysms: treatment with juxtarenal placement of
  covered stent-grafts.

In: Radiology (1998 Jan) 206(1):195-8

ISSN: 0033-8419

PURPOSE: To determine the technical feasibility and clinical outcome
  of juxtarenal placement of covered stent-grafts for endovascular
  treatment of abdominal aortic aneurysms with a proximal neck less
  than 15 mm long. MATERIALS AND METHODS: In seven patients, abdominal
  aortic aneurysms with infrarenal necks 3-14 mm long were excluded
  with juxtarenal implantation of polyester-nitinol coknit stent-
  grafts. The proximal uncovered portion of the stent-graft (length, 12
  mm) was placed across one or both orifices of the renal arteries.
  Seven patients underwent standard infrarenal stent-graft placement.
  Clinical outcome in all 14 patients was determined with computed
  tomography (CT) and laboratory values and also with captopril
  renography in the patients who underwent juxtarenal placement. The
  mean follow-up was 10.1 months. RESULTS: Findings from serial follow-
  up CT and laboratory analysis performed in all patients and captopril
  renography performed in five of the patients who underwent juxtarenal
  stent-graft placement did not reveal impaired renal function or
  perfusion. CONCLUSION: Successful exclusion of abdominal aortic
  aneurysms located closer than 15 mm to the orifices of the renal
  arteries is possible with juxtarenal placement of the uncovered
  portion of the stent in the abdominal portion of the aorta.

Registry Numbers: 52013-44-2 (nitinol)
                       66108-95-0 (Iohexol)
                       73334-07-3 (iopromide)

Institutional address:
     Department of Radiology
     Eberhard-Karls-Universitat
     Tubingen
     Germany.

(REFERENCE 19 OF 20)
96123137

Blum U  Langer M  Spillner G  Mialhe C 
  Beyersdorf F  Buitrago-Tellez C 
  Voshage G  Duber C  Schlosser V 
  Cragg AH 
Abdominal aortic aneurysms: preliminary technical and clinical
  results with transfemoral placement of endovascular self-expanding
  stent-grafts [see comments]

In: Radiology (1996 Jan) 198(1):25-31

ISSN: 0033-8419

PURPOSE: To evaluate treatment of infrarenal abdominal aortic
  aneurysm (AAA) with a new endoluminal stent-graft. MATERIALS AND
  METHODS: In 26 male patients, straight or bifurcated nitinol stents
  covered with woven Dacron graft material were implanted to treat
  eccentric saccular AAA (n = 3) or AAA involving the bifurcation and
  common iliac arteries (n = 23), with follow-up from 8 days to 8 1/2
  months. RESULTS: Implantation was technically successful in all but
  one of the 26 (96%) patients (leak of the stent-graft for more than 3
  months necessitated implantation of an additional covered stent). In
  seven of the 26 patients, minor residual perfusion persisted
  immediately after implantation, but complete thrombosis occurred
  within 7 days. Five procedure-related complications occurred: distal
  embolization (n = 2); local hematoma, which necessitated surgery (n =
  1); acute hepatic failure due to gastric bleeding, in a patient with
  liver cirrhosis (n = 1); and stent-graft occlusion due to emboli
  originating from the left atrium (n = 1). CONCLUSION: Exclusion of
  AAA from circulation was feasible, safe, and clinically effective
  with the new stent-graft.

Comment in: Radiology 1996 Jan;198(1):14-6

Registry Numbers: 52013-44-2 (nitinol)

Institutional address:
     Department of Diagnostic Radiology
     University Hospital Freiburg
     Germany.


*****SURGICAL CLINICS OF NORTH AMERICA*****

(REFERENCE 20 OF 20)
99108729

D'Ayala M  Hollier LH  Marin ML 
Endovascular grafting for abdominal aortic aneurysms.

In: Surg Clin North Am (1998 Oct) 78(5):845-62

ISSN: 0039-6109

Despite the initial success of endovascular grafts in a very
  difficult patient population, many problems remain. These procedures
  are often time-consuming and quite complicated, requiring the close
  cooperation of an experienced team of vascular surgeons and
  interventional radiologists. Access may be difficult through
  occluded, stenotic, and tortuous vessels. Inadequate graft deployment
  may result in arterial rupture or graft migration, which could
  potentially lead to acute occlusion of the renal or iliac arteries.
  Occlusion of the inferior mesenteric artery may result in ischemic
  colitis. Also, endovascular grafts may fail to exclude an aneurysm
  from systemic arterial blood pressure, not protecting the patient
  against impending rupture, and embolization and thrombosis are ever-
  present dangers. Concerns have been raised regarding radiation
  exposure and intravenous contrast loads used during these procedures.
  Clearly, more experience must be gained and technologic advancements
  made before the use of these devices becomes commonplace, something
  that may not be too far off in the future.

Institutional address:
     Department of Surgery
     Mount Sinai Medical Center
     New York
     New York