Advertisement

Aortic Stent Grafting

Percutaneous and Surgical Approaches
  • Omaida C. Velazquez
  • Edward Woo
  • Ronald M. Fairman
Part of the Contemporary Cardiology book series (CONCARD)

Abstract

Parodi published the first series of abdominal aortic aneurysms repaired using endovascular techniques (1). Since then, the field of aortic aneurysm treatment has been revolutionized by fast technological advancements in catheter-based covered stent-grafts. In the United States, clinical studies began only a few years after Parodi’s pioneering work (2,3) and trials have progressed rapidly since then, fueled by industry support and cheered by both physicians and patients. To date, four devices have been approved by the Food and Drug Administration (FDA) (Ancure, Guidant/EVT, Menlo Park, CA; AneuRx, Medtronics, Santa Rosa, CA; Excluder, W.L. Gore & Associates, Flagstaff, AZ; Zenith, Cook, Bloomington, IN). One of the four (Ancure) has been withdrawn from the market by Guidant. In addition, numerous other devices are currently undergoing clinical trials. The FDA-approved devices can be used for the abdominal aorta, but ongoing trials are exploring the use of similar endovascular technologies for aneurysms of the thoracic aorta. Currently, a length of at least 15 mm for the proximal aortic neck and a 20-mm-long landing zone in the common iliac arteries away from any major named arterial branch are a prerequisite for being able to exclude an aneurysm by endovascular approaches. However, ongoing experimental techniques continue to push the frontiers of the endovascular approach by attempting to design ways in which one can maneuver around aortic branches, move them out of the way, or reconstruct stent-graft branches as part of the repair. Similarly, although currently a femoral cut-down is routinely used for endovascular aneurysm exclusion, the frontier of completely percutaneous aneurysm repair is actively being sought by numerous investigators and industry bioengineers. Currently, despite some early setbacks and still evolving technology, commercially manufactured endovascular systems are employed to treat abdominal aortic aneurysms (AAAs) in about 50% of elective aneurysm repairs and are continuing to spread widely throughout the world (4).

Keywords

Aortic Aneurysm Iliac Artery Abdominal Aortic Aneurysm Internal Iliac Artery Endovascular Repair 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Parodi, JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991;5(6):491–499.PubMedCrossRefGoogle Scholar
  2. 2.
    Edwards WH Jr, et al. Endovascular grafting of abdominal aortic aneurysms. A preliminary study. Ann Surg 1996;223(5):568–573; discussion 573–575.PubMedCrossRefGoogle Scholar
  3. 3.
    Harris PL. The highs and lows of endovascular aneurysm repair: the first two years of the Eurostar Registry. Ann R Coll Surg Engl 1999;81(3):161–165.PubMedGoogle Scholar
  4. 4.
    Bertrand M, et al. Endovascular treatment of abdominal aortic aneurysms: is there a benefit regarding postoperative outcome? Eur J Anaesthesiol 2001;18(4):245–250.PubMedCrossRefGoogle Scholar
  5. 5.
    Becquemin JP, et al. Mid-term results of a second generation bifurcated endovascular graft for abdominal aortic aneurysm repair: the French Vanguard trial. J Vasc Surg 1999;30(2):209–218.PubMedCrossRefGoogle Scholar
  6. 6.
    Ceelen W, et al. Cost-benefit analysis of endovascular versus open abdominal aortic aneurysm treatment. Acta Chir Belg 1999;99(2):64–67.PubMedGoogle Scholar
  7. 7.
    Velazquez OC, et al. Gender-related differences in infrarenal aortic aneurysm morphologic features: issues relevant to Ancure and Talent endografts. J Vasc Surg 2001;33(2 Suppl):S77–S84.PubMedCrossRefGoogle Scholar
  8. 8.
    Velazquez OC, Woo EY, Carpenter JP, et al. Decreased use of iliac extensions and reduced graft junctions with software-assisted centerline measurements in seclection of endograft components for endovascular aneurysm repair. J Vasc Surg in press. 2004;40:222–227.CrossRefGoogle Scholar
  9. 9.
    Carpenter JP, et al. Multicenter pivotal trial results of the Lifepath System for endovascular aortic aneurysm repair. J Vasc Surg 2004;39(1):34–43.PubMedCrossRefGoogle Scholar
  10. 10.
    Velazquez OC, et al. Relationship between preoperative patency of the inferior mesenteric artery and subsequent occurrence of type II endoleak in patients undergoing endovascular repair of abdominal aortic aneurysms. J Vasc Surg 2000;32(4):777–788.PubMedCrossRefGoogle Scholar
  11. 11.
    Baum RA, et al. Diagnosis and treatment of inferior mesenteric arterial endoleaks after endovascular repair of abdominal aortic aneurysms. Radiology 2000;215(2):409–413.PubMedGoogle Scholar
  12. 12.
    Zarins CK, et al. Stent graft migration after endovascular aneurysm repair: importance of proximal fixation. J Vasc Surg 2003;38(6):1264–1272; discussion 1272.PubMedCrossRefGoogle Scholar
  13. 13.
    Zarins CK, The US AneuRx Clinical Trial: 6-year clinical update 2002. J Vasc Surg 2003;37(4): 904–908.PubMedCrossRefGoogle Scholar
  14. 14.
    Cao P, et al. Device migration after endoluminal abdominal aortic aneurysm repair: analysis of 113 cases with a minimum follow-up period of 2 years. J Vasc Surg 2002;35(2):229–235.PubMedCrossRefGoogle Scholar
  15. 15.
    Conner MS, 3rd, et al. Secondary procedures after endovascular aortic aneurysm repair. J Vasc Surg 2002;36(5):992–996.PubMedCrossRefGoogle Scholar
  16. 16.
    Arko FR. Regarding “Endograft migration one to four years after endovascular abdominal aortic aneurysm repair with the AneuRx device: a cautionary note.” J Vasc Surg 2003;37(4):916; author reply 916–918.PubMedCrossRefGoogle Scholar
  17. 17.
    Greenberg RK, et al. Variable sac behavior after endovascular repair of abdominal aortic aneurysm: analysis of core laboratory data. J Vasc Surg 2004;39(1):95–101.PubMedCrossRefGoogle Scholar
  18. 18.
    Fairman RM, et al. Limb interventions in patients undergoing treatment with an unsupported bifurcated aortic endograft system: a review of the Phase II EVT Trial. J Vasc Surg 2002;36(1):118–126.PubMedCrossRefGoogle Scholar
  19. 19.
    Carpenter JP, et al. Failure of endovascular abdominal aortic aneurysm graft limbs. J Vasc Surg 2001; 33(2):296–302; discussion 302–303.PubMedCrossRefGoogle Scholar
  20. 20.
    Baum RA, et al. Limb kinking in supported and unsupported abdominal aortic stent-grafts. J Vasc Intervent Radiol, 2000;11(9):1165–1171.CrossRefGoogle Scholar
  21. 21.
    Moore WS, et al. Five-year interim comparison of the Guidant bifurcated endograft with open repair of abdominal aortic aneurysm. J Vasc Surg 2003;38(1):46–55.PubMedCrossRefGoogle Scholar
  22. 22.
    Moore WS. The Guidant Ancure bifurcation endograft: five-year follow-up. Semin Vasc Surg 2003; 16(2):139–143.PubMedCrossRefGoogle Scholar
  23. 23.
    Zarins CK, et al. AneuRx stent graft versus open surgical repair of abdominal aortic aneurysms: multicenter prospective clinical trial. J Vasc Surg 1999;29(2):292–305; discussion 306–308.PubMedCrossRefGoogle Scholar
  24. 24.
    Zarins CK, White RA. Fogarty TJ. Aneurysm rupture after endovascular repair using the AneuRx stent graft. J Vasc Surg 2000;31(5):960–970.PubMedCrossRefGoogle Scholar
  25. 25.
    Zarins CK, et al. The AneuRx stent graft: four-year results and worldwide experience 2000. J Vasc Surg 2001;33(2 Suppl.):S135–S145.PubMedCrossRefGoogle Scholar
  26. 26.
    Ramaiah VG, et al. The AneuRx stent-graft since FDA approval: single-center experience of 230 cases. J Endovasc Ther 2002;9(4):464–469.PubMedCrossRefGoogle Scholar
  27. 27.
    Ayerdi J, et al. Indications and outcomes of AneuRx Phase III trial versus use of commercial AneuRx stent graft. J Vasc Surg 2003;37(4):739–743.PubMedCrossRefGoogle Scholar
  28. 28.
    Zarins CK, et al. Aneurysm enlargement following endovascular aneurysm repair: AneuRx clinical trial. J Vasc Surg 2004;39(1):109–117.PubMedCrossRefGoogle Scholar
  29. 29.
    Matsumura JS, et al. A multicenter controlled clinical trial of open versus endovascular treatment of abdominal aortic aneurysm. J Vasc Surg 2003;37(2):262–271.PubMedCrossRefGoogle Scholar
  30. 30.
    Greenberg RK, et al. An update of the Zenith endovascular graft for abdominal aortic aneurysms: initial implantation and mid-term follow-up data. J Vasc Surg 2001;33(2 Suppl.):S157–S164.PubMedCrossRefGoogle Scholar
  31. 31.
    Sternbergh WC, 3rd, et al. Influence of endograft oversizing on device migration, endoleak, aneurysm shrinkage, and aortic neck dilation: results from the Zenith Multicenter Trial. J Vasc Surg 2004;39(1): 20–76.PubMedCrossRefGoogle Scholar
  32. 32.
    Carpenter JP. Multicenter trial of the PowerLink bifurcated system for endovascular aortic aneurysm repair. J Vasc Surg 2002;36(6):1129–1137.PubMedCrossRefGoogle Scholar
  33. 33.
    Criado FJ, Fairman RM, Becker GJ. Talent LPS AAA stent graft: results of a pivotal clinical trial. J Vasc Surg 2003;37(4):709–715.PubMedCrossRefGoogle Scholar
  34. 34.
    Ouriel K, et al. Endovascular repair of abdominal aortic aneurysms: device-specific outcome. J Vasc Surg 2003;37(5):991–998.PubMedCrossRefGoogle Scholar
  35. 35.
    Bickerstaff LK, et al. Thoracic aortic aneurysms: a population-based study. Surgery 1982;92(6): 1103–1108.PubMedGoogle Scholar
  36. 36.
    Crawford ES, et al. Thoracoabdominal aortic aneurysms: preoperative and intraoperative factors determining immediate and long-term results of operations in 605 patients. J Vasc Surg 1986;3(3):389–404.PubMedCrossRefGoogle Scholar
  37. 37.
    Dake MD, et al. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med 1994;331(26):1729–1734.PubMedCrossRefGoogle Scholar
  38. 38.
    Mitchell RS, Miller DC, Dake MD. Stent-graft repair of thoracic aortic aneurysms. Semin Vasc Surg 1997;10(4):257–271.PubMedGoogle Scholar
  39. 39.
    Temudom T, et al. Endovascular grafts in the treatment of thoracic aortic aneurysms and pseudoaneurysms. Ann Vasc Surg 2000;14(3):230–238.PubMedCrossRefGoogle Scholar
  40. 40.
    Ehrlich M, et al. Endovascular stent graft repair for aneurysms on the descending thoracic aorta. Ann Thorac Surg 1998;66(1):19–24; discussion 24–25.PubMedCrossRefGoogle Scholar
  41. 41.
    Criado FJ, et al. Technical strategies to expand stent-graft applicability in the aortic arch and proximal descending thoracic aorta. J Endovasc Ther 2002;9(Suppl. 2):II32–II38.PubMedGoogle Scholar
  42. 42.
    Criado FJ, Clark NS, Barnatan MF. Stent graft repair in the aortic arch and descending thoracic aorta: a 4-year experience. J Vasc Surg 2002;36(6):1121–1128.PubMedCrossRefGoogle Scholar
  43. 43.
    Fairman RM, Stent grafting in the thoracic aorta. Endovasc Today 2003:3–5.Google Scholar
  44. 44.
    Razavi MK, et al. Internal iliac artery embolization in the stent-graft treatment of aortoiliac aneurysms: analysis of outcomes and complications. J Vasc Interv Radiol 2000;11(5):561–566.PubMedCrossRefGoogle Scholar
  45. 45.
    Criado FJ, et al. Safety of coil embolization of the internal iliac artery in endovascular grafting of abdominal aortic aneurysms. J Vasc Surg 2000;32(4):684–688.PubMedCrossRefGoogle Scholar
  46. 46.
    Velmahos GC, et al. Angiographic embolization of bilateral internal iliac arteries to control life-threatening hemorrhage after blunt trauma to the pelvis. Am Surg 2000;66(9):858–862.PubMedGoogle Scholar
  47. 47.
    Yano OJ, et al. Ancillary techniques to facilitate endovascular repair of aortic aneurysms. J Vasc Surg 2001;34(1):69–75.PubMedCrossRefGoogle Scholar
  48. 48.
    Chuter TA, Reilly LM. Surgical reconstruction of the iliac arteries prior to endovascular aortic aneurysm repair. J Endovasc Surg 1997;4(3):307–311.PubMedCrossRefGoogle Scholar
  49. 49.
    White GH, et al. Type III and type IV endoleak: toward a complete definition of blood flow in the sac after endoluminal AAA repair. J Endovasc Surg 1998;5(4):305–309.PubMedCrossRefGoogle Scholar
  50. 50.
    White GH, Yu, W, May J. Endoleak—a proposed new terminology to describe incomplete aneurysm exclusion by an endoluminal graft. J Endovasc Surg 1996;3(1):124–125.PubMedCrossRefGoogle Scholar
  51. 51.
    White GH, et al. Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management. J Endovasc Surg 1997;4(2):152–168.PubMedCrossRefGoogle Scholar
  52. 52.
    White GH, et al. Endotension: an explanation for continued AAA growth after successful endoluminal repair. J Endovasc Surg 1999;6(4):308–315.PubMedCrossRefGoogle Scholar
  53. 53.
    Kasirajan K, et al. Technique and results of transfemoral superselective coil embolization of type II lumbar endoleak. J Vasc Surg 2003;38(1):61–66.PubMedCrossRefGoogle Scholar
  54. 54.
    Heller JA, et al. Two decades of abdominal aortic aneurysm repair: have we made any progress? J Vasc Surg 2000;32(6):1091–1100.PubMedCrossRefGoogle Scholar
  55. 55.
    Taylor LM, Jr., and Porter JM. Basic data related to clinical decision-making in abdominal aortic aneurysms. Ann Vasc Surg 1987;1(4):502–504.PubMedCrossRefGoogle Scholar
  56. 56.
    Lombardi JV, Fairman RM, Carpenter JC, et al. The utility of commercially available endografts in the treatment of contained-ruptureed AAA with hemodynamic stability. J Vasc Surg 2004;40:154–160.PubMedCrossRefGoogle Scholar
  57. 57.
    Ohki T, Veith FJ. Endovascular therapy for ruptured abdominal aortic aneurysms. Adv Surg 2001;35: 131–151.PubMedGoogle Scholar
  58. 58.
    Veith FJ, Gargiulo NJ 3rd, Ohki T. Endovascular treatment of ruptured infrarenal aortic and iliac aneurysms. Acta Chir Belg 2003;103(6):555–562.PubMedGoogle Scholar
  59. 59.
    Veith FJ, et al. Endovascular grafts and other catheter-directed techniques in the management of ruptured abdominal aortic aneurysms. Semin Vasc Surg 2003;16(4):326–331.PubMedCrossRefGoogle Scholar
  60. 60.
    Veith FJ, et al. Treatment of ruptured abdominal aneurysms with stent grafts: a new gold standard? Semin Vasc Surg 2003;16(2):171–175.PubMedCrossRefGoogle Scholar
  61. 61.
    Greenberg RK, et al. An endoluminal method of hemorrhage control and repair of ruptured abdominal aortic aneurysms. J Endovasc Ther 2000;7(1):1–7.PubMedCrossRefGoogle Scholar
  62. 62.
    Hinchliffe RJ, et al. Endovascular repair of ruptured abdominal aortic aneurysm—a challenge to open repair? Results of a single centre experience in 20 patients. Eur J Vasc Endovasc Surg 2001;22(6):528–534.PubMedCrossRefGoogle Scholar
  63. 63.
    Hinchliffe RJ, Hopkinson BR. Ruptured abdominal aortic aneurysm. Time for a new approach. J Cardiovasc Surg (Torino) 2002;43(3):345–347.Google Scholar
  64. 64.
    Walker EM, Hopkinson BR, Makin GS. Unoperated abdominal aortic aneurysm: presentation and natural history. Ann R Coll Surg Engl 1983;65(5):311–313.PubMedGoogle Scholar
  65. 65.
    Tron C, et al. Arandomized comparison of a percutaneous suture device versus manual compression for femoral artery hemostasis after PTCA. J Intervent Cardiol 2003;16(3):217–221.PubMedCrossRefGoogle Scholar
  66. 66.
    Yadav JS, et al. Comparison of the QuickSeal Femoral Arterial Closure System with manual compression following diagnostic and interventional catheterization procedures. Am J Cardiol 2003; 91(12):1463–1466.PubMedCrossRefGoogle Scholar
  67. 67.
    Traul DK, et al. Percutaneous endovascular repair of infrarenal abdominal aortic aneurysms: a feasibility study. J Vasc Surg 2000;32(4):770–776.PubMedCrossRefGoogle Scholar
  68. 68.
    Torsello GB, et al. Endovascular suture versus cutdown for endovascular aneurysm repair: a prospective randomized pilot study. J Vasc Surg 2003;38(1):78–82.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2005

Authors and Affiliations

  • Omaida C. Velazquez
    • 1
  • Edward Woo
    • 1
  • Ronald M. Fairman
    • 1
  1. 1.Department of SurgeryUniversity of Pennsylvania School of MedicinePhiladelphia

Personalised recommendations