SciELO - Scientific Electronic Library Online

 
vol.50 issue2Laparotomy for blunt abdominal trauma in a civilian trauma serviceIntussusception in children: Experience with 105 patients in a department of paediatric surgery, Turkey author indexsubject indexarticles search
Home Pagealphabetic serial listing  

South African Journal of Surgery

On-line version ISSN 2078-5151
Print version ISSN 0038-2361

S. Afr. j. surg. vol.50 n.2 Cape Town May. 2012

 

VASCULAR SURGERY

 

Repair of abdominal aortic aneurysms with aorto-uni-iliac stentgraft and femoro-femoral bypass

 

 

J. G. M. SmitI; J. van MarleII

IM.B. Ch.B., F.C.S. (S.A.), M.Med. (Surg.).; Department of Surgery, University of Pretoria
IIM.B. Ch.B., F.C.S. (S.A.), M.Med. (Surg.).; Unitas Unit for Vascular Surgery, Department of Surgery, University of Pretoria

 

 


ABSTRACT

OBJECTIVES: Endovascular repair (EVAR) is accepted as effective treatment for abdominal aortic aneurysms (AAAs) and has become the standard of care in many instances. The standard bifurcated stentgraft (BFG) is often not possible in patients with unfavourable aneurysm morphology. The aorto-uni-iliac (AUI) graft configuration with femoro-femoral bypass (FFBP) is a promising alternative which may extend the scope of EVAR for AAAs. The aim of this study was to evaluate the feasibility, efficacy and durability of AUI with FFBP.
DESIGN: The results of a single institution and a single surgeon were prospectively collected from January 2002 to August 2010. All patients were followed up at 1, 3, 6 and 12 months and then annually.
RESULTS: There were 33 patients (27 males) with a mean age of 71.7 years (range 46 - 84). Open surgery posed an unacceptably high risk to all patients owing to advanced age and/or American Society of Anesthesiologists (ASA) classification 3/4. Ineligibility for BFG was due to unfavourable anatomy or a combination of factors in most cases (31 patients). Two patients had anastomotic aneurysms after previous open surgery.
The technical success rate was 100%. One severe intra-operative complication occurred (perforated iliac artery). Two patients (ASA 4) died within 30 days (peri-operative mortality rate 6.1%). Seven patients (21.1%) developed postoperative wound complications. Eight patients died during follow-up of non-aneurysm-related conditions. Twenty-three patients are alive, with mean follow-up of 24.4 months and a survival rate of 69.7%. Two complications occurred during long-term follow-up, namely 1 case of graft sepsis and 1 of FFBP occlusion.
CONCLUSION: AUI with FFBP is a safe, effective and durable alternative in high-risk patients with AAAs where standard open repair is contraindicated and BFG repair is not possible owing to unfavourable aneurysm morphology.


 

“Full text available only in PDF format”

 

REFERENCES

1. Greenhalgh RM, Brown LC, Kwong GPS, Powell JT, Thompson SG. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 2004;364:843-848.         [ Links ]

2. Prinssen M, Verhoeven EL, Buth J, et al. Randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 2004;351:1607-1618.         [ Links ]

3. Lederle FA, Freischlag JA, Kiriakides DC, et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: randomized trial. JAMA 2009;302:1535-1542.         [ Links ]

4. Darin Clouse D, Brewster C, Marone LK, Cambria RP. Durability of aortomonoilaic endografting with femorofemoral crossover: 4-year experience in the EVT/Guidant trails. J Vasc Surg 2003;37:1142-1149.         [ Links ]

5. Hinchliffe RJ, Alric P, Wenham PW, Hopkinson BR. Durability of femorofemoral bypass grafting after aortauniiliac endovascular aneurysm repair. J Vasc Surg 2003;38:498-503.         [ Links ]

6. Lazardis J, Melas M, Athanasios S, Saratzis N. Reporting mid- and long-term results of endovascular grafting for abdominal aortic aneurysms using the aortamonoiliac configuration. J Vasc Surg 2009;50:8-14.         [ Links ]

7. Walker SR, Braithwaite B, Tennant WG, MacSweeney ST. Early complications of femorofemoral crossover bypass after aorta uni-iliac endovascular repair of abdominal aortic aneurysms. J Vasc Surg 1998;28:647-50.         [ Links ]

8. Yilmaz PK, Abraham CZ, Reilly LM. Is cross-femoral bypass grafting a disadvantage of aortomonoiliac endovascular aortic aneurysm repair? J Vasc Surg 2003;38:753-757.         [ Links ]

9. Saratzis N, Melas N, Lazaridis J, Ginis G. Endovascular AAA repair with the aortomonoiliac Endofit stent-graft: Two years' experience. J Endovasc Trier 2005;12(3):280-287.         [ Links ]

10. Rutherford RB, Krupsi WC. Current status of open versus endovascular stent-graft repair of abdominal aortic aneurysm. J Vasc Surg 2004;39:1129-1139.         [ Links ]

11. Carpenter JP, Baum RA, Barker CF, et al. Durabillity of benefits of endovascular versus conventional AAA repair. J Vasc Surg 2002;35:222-228.         [ Links ]

12. Moore WS, Kashyap VS, Vescera CL, Quinones-Baldrich WJ. Abdominal aortic aneurysm: a 6-year comparison of endovascular versus transabdominal repair. Ann Surg 1999;230:298-308.         [ Links ]

13. Schwarze ML, Shen Y, Hemmerich G, et al. Age-related trends in utilization and outcome of open and endovascular repair for abdominal aortic aneurysms in the United States, 2001 - 2006. J Vasc Surg 2009;50:722-729.         [ Links ]

14. Diehm N, Tsoukas A, Katzen BT, et al. Matched-paired analysis of endovascular vs open surgical repair of abdominal aortic aneurysms in young patients at low risk. J Vasc Interv Radiol 2008;19:645-651.         [ Links ]

15. Winterborn RJ, Amin I, Lyratzopoulos G, et al. Preferences for endovascular (EVAR) or open surgical repair amongst patients with abdominal aortic aneurysms under surveillance. J Vasc Surg 2009;49:576-581.         [ Links ]

16. May J, White G, Waugh R, Yu W, Harris J. Treatment of complex aortic aneurysms by a combination of endoluminal and extraluminal femoral grafts. J Vasc Surg 1994;19:924-933.         [ Links ]

17. Parodi JC. Endovascular repair of abdominal aortic aneurysms and other arterial lesions. J Vasc Surg 1995;21:549-557.         [ Links ]

18. Marin ML, Veith FJ, Cynamon J. Initial experience with transluminally placed endovascular grafts for the treatment of complex vascular lesions. Ann Surg 1995;22:449-469.         [ Links ]

19. Eugene J, Goldstone J, Moore WS. Fifteen-year experience with subcutaneous bypass grafts for lower limb extremity ischemia. Ann Surg 1977;186:177-183.         [ Links ]

20. Brief DK, Brenner BJ. Extra-anatomic bypass: femoro-femoral crossover grafts. In: Wilson SE, Veith FJ, Hobson RW, eds. Vascular Surgery: Principles and Practice. New York: McGraw-Hill, 1987:415-418.         [ Links ]

21. Dick LS, Brief DK, Alpert J, Brenner BJ, Goldenkranz R, Parsonnet V. A 12-year experience with femorofemoral crossover grafts. Arch Surg 1980;115:1359-1365.         [ Links ]

22. Mosley JG, Marston A. Long-term results of 66 femorofemoral bypass grafts: 9-year follow-up. Br J Surg 1983;70:631-634.         [ Links ]

23. Craido E, Burnham SJ, Tinsley EA Jr, Johnson G Jr, Keagy BA. Femorofemoral bypass grafts: analysis of patency and factors influencing long term outcome. J Vasc Surg 1993;18:495-504.         [ Links ]

24. Mingoli A, Sapienza P, Feldhaus RJ, Di Marzo L, Burchi C, Cavalloro A. Femorofemoral bypass grafts: factors influencing long-term patency rates and outcome. Surgery 2001;129:451-457.         [ Links ]

25. Van Marle J, Mistry PP. Endovascular aneurysm repair (EVAR) in patients at increased risk for open repair. Presented at the VASSA Congress, Durban, 19 - 21 July 2006.         [ Links ]

26. Greenhalgh RM, Brown LC, Epstein D, et al. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet 2005;365:2187-2192.         [ Links ]

27. Hinchliffe RJ, Yusuf SW, Macierewicz JA, 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;22:528-534.         [ Links ]

28. Peppelenbosch N, Yilmaz N, Van Marrewijk C, et al. Emergency treatment of acute symptomatic or ruptured abdominal aortic aneurysm: Outcome of a prospective intent-to-treat by EVAR protocol. Eur J Vasc Endovasc Surg 2003;26:303-310.         [ Links ]

29. Lachat ML, Pfammatter T, Witzke HJ, et al. Endovascular repair with bifurcated stent-grafts under local anaesthesia to improve outcome of ruptured aortoiliac aneurysms. Eur J Endovasc Surg 2002;23:528-536.         [ Links ]

30. Van Marle J, Mistry PP. Endovascular management of ruptured abdominal aortic aneurysm. Presented at the Wits 20th Biennial Congress, Johannesburg, 28 - 31 May 2006.         [ Links ]

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License