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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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ORIGINAL ARTICLES  NEW RESULTS IN THE ENDOVASCULAR MANAGEMENT OF ABDOMINAL AORTIC ANEURYSMS


The Journal of Cardiovascular Surgery 2010 Agosto;51(4):461-6

lingua: Inglese

Use of the Aorfix™ stent graft in patients with tortuous iliac anatomy

Weale A. R. 1, Balasubramaniam K. 2, Hardman J. 2, Horrocks M. 1

1 Department of Vascular Surgery, Royal United Hospital, Coombe Park, Bath BA1 3NG, UK;
2 Department of Radiology, Royal United Hospital, Coombe Park, Bath BA1 3NG, UK


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AIM: Iliac limb occlusion following endovascular repair (EVAR) may result in limb threatening acute ischemia. The incidence is reported at up to 10% and is known to be influenced by iliac angulation and kinking of the stent graft. The aim of this study was to evaluate the performance of the Aorfix™ graft in tortuous iliac anatomy and examine the impact of the graft on the rate of iliac limb thrombosis following EVAR in a single UK centre
METHODS: We performed a retrospective review of all EVAR performed from May 1998 to May 2010. From November 2007, patients with highly angulated iliac anatomy were treated with the Aorfix™(Lombard) stent graft, or when a Zenith™(Cook) main body was chosen, the Aorfix™ iliac limbs were used with the Zenith™(Cook) device. We compared the rate of iliac limb occlusions before (group 1) and after (group 2) the adoption of this policy.
RESULTS: Two hundred and sixty seven patients underwent EVAR (group 1 n=129; group 2 n=138). In group 1, eight patients had a unilateral iliac limb occlusion (6.2%). Six of the patients had >90° iliac angulation, one had an unrecognised limb stenosis, and one patient had the stent landed in the external iliac. In group 2 there were no limb occlusions. Of the 138 patients, 25 had iliac angulation of >90°. Of these 25, eighteen were treated with the Aorfix™ stent graft system because of iliac angulation, and 7 were treated with Aorfix™ legs and Zenith™ bodies.
CONCLUSION: The rate of early iliac limb occlusion following EVAR in patients with angulated iliac anatomy can be substantially reduced by using the flexible Aorfix® stent graft system.

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john.hardman@ruh-bath.swest.nhs.uk