肾动脉下腹主动脉瘤腔内修复术10例治疗体会

目的总结肾动脉下腹主动脉瘤腔内修复术的初步经验。方法对我院2006年8月至2009年3月期间收治的10例肾动脉下腹主动脉瘤患者在全麻下采用单侧或双侧股动脉入路置入带膜支架行腔内修复术。结果10例肾动脉下腹主动脉瘤采用腔内修复治疗,带膜支架置入顺利,立即DSA7例动脉瘤体消失,Ⅰ型内瘘2例,经支架附着点球囊扩张后内瘘即刻消失。随访3～30个月(平均10个月),2例术后切口淋巴瘘,经换药痊愈。全部患者肢体血运正常。1例发生Ⅱ型内瘘,未经治疗,随访2个月后消失。结论腔内修复术对肾动脉下腹主动脉瘤是一种创伤小、恢复快及效果好的治疗方法。     

杂交手术治疗胸腹主动脉瘤

目的:回顾近8年我院使用杂交技术(腹腔内脏动脉去分支加主动脉瘤腔内修复)治疗胸腹主动脉瘤的病例,总结随访结果并分析并发症发生原因。方法:对2007年8月至2015年3月我院以杂交手术治疗的13例胸腹主动脉瘤病人的临床资料进行回顾性研究。手术方法为一期先行腹腔内脏动脉去分支手术,二期行腔内修复术。结果:13例胸腹主动脉瘤病人Ⅱ型3例,Ⅲ型3例,Ⅳ型5例,马凡综合征A型夹层全弓置换术后2例。一期行内脏动脉去分支手术,其中以升主动脉为流入道行腹腔内脏动脉顺行去分支5例,以髂动脉或腹主动脉下段为流入道行腹腔内脏动脉逆行去分支8例。二期行胸腹主动脉瘤覆膜支架腔内修复术。病例无截瘫发生。围手术期1例死于弥漫性血管内凝血;因肾动脉人工血管闭塞,术后肾功能不全需长期血透1例。结论:杂交技术治疗胸腹主动脉瘤创造了良好的支架移植物锚定区,并完整保留了内脏动脉的血供,是一种有效的治疗方法。但去分支手术创伤较大,仍有术后发生凝血功能障碍、慢性肾功能不全的风险。尤其在瘤体巨大时肾动脉的显露及重建困难。     

破裂腹主动脉瘤的外科治疗及预后

目的探讨破裂腹主动脉瘤的诊断、治疗方法及影响预后的因素。方法回顾性分析1999年4月至2005年12月期间我院收治的23例肾动脉下破裂腹主动脉瘤患者的临床资料，其中男15例，女8例；年龄35～78岁，平均65岁。自知有腹主动脉瘤者7例，有腹部搏动性包块者6例，术前行急诊彩超和（或）CT检查确诊15例。所有患者均行急诊手术治疗。根据术中情况采取肾动脉下腹主动脉钳夹阻断或腹主动脉腔内球囊阻断，控制出血后行人造血管移植术。结果手术后30d内死亡9例（39％），死亡原因为出血性休克所致的急性肾功能衰竭4例、多器官功能衰竭3例、呼吸循环衰竭2例。结论手术治疗是对破裂腹主动脉瘤的有效治疗，根据术中情况采取不同的方法阻断破裂口近端腹主动脉以控制出血是手术的关键。急性心脑血管疾病、急性肾功能衰竭及肺部并发症是术后的主要并发症及死亡原因。     

主动脉瘤40例治疗体会

目的介绍外科与腔内隔绝术治疗主动脉瘤的体会。方法手术与腔内隔绝术治疗主动脉瘤40例,手术治疗30例,Bentall术9例,Bentall 部分弓置换3例,主动脉瘤切除人工血管置换6例,主动脉瘤切除补片修补4例,升主动脉 部分弓置换、主动脉瓣二尖瓣置换 升主动脉折叠缝合术各2例,主动脉瓣置换 升主动脉置换、主动脉瓣置换升主动脉折叠缝合术、主动脉瘤切除直接缝合、主动脉瘤切除人工血管置换 左全肺切除术各1例。腔内隔绝术治疗假性胸降主动脉瘤1例、假性腹主动脉瘤1例、夹层主动脉瘤ⅢA型1例、ⅢB型7例,经股动脉切口植入32~38mm覆膜支架。结果手术后因低心排出量综合征和出血各死亡1例,死亡率6.7%,无截瘫、偏瘫和感染。覆膜支架腔内隔绝术后1~2周内低热8例,无大出血、内漏和死亡。生存38例,随访1个月~5年,无死亡和远期并发症。结论升弓部主动脉瘤的手术治疗效果满意,覆膜支架腔内隔绝治疗DeBakeyⅢ型夹层主动脉瘤创伤小、并发症少、恢复快。     

肾动脉平面下腹主动脉瘤的外科治疗

目的：探讨肾动脉平面下腹主动脉瘤的外科治疗经验。方法：传统开放手术治疗27例中择期手术19例,动脉瘤破裂行急症手术8例;腔内手术治疗4例。结果：围手术期并发心力衰竭3例,呼吸衰竭8例,急性心肌梗死1例,急性肾功能衰竭4例,术后严重出血1例,死亡5例,余均治愈。结论：外科手术是治疗肾动脉平面下腹主动脉瘤的有效手段,而腔内治疗以其安全、微创、对人体内环境干扰小等优点将成为未来发展的趋势。     

瘤颈捆扎治疗腹主动脉瘤腔内修复术后持续内漏的疗效分析

目的总结瘤颈捆扎治疗腹主动脉瘤腔内修复术后持续内漏的疗效。方法回顾性分析2019年6月至2022年4月北京大学人民医院10例行瘤颈捆扎手术患者的临床及随访资料。结果手术指征为术后持续Ⅰ型内漏6例、Ⅱ型内漏3例、存在内张力1例, 均合并动脉瘤增大或破裂。全麻下经腹入路套带控制肾下近端瘤颈后使用捆扎带进行加固。10例患者均获得手术成功, 无内漏残留, 无支架移植物闭塞。围手术期并发症包括1例伤口愈合延迟和1例不完全性肠梗阻, 无围手术期死亡。中位随访时间13个月, 未发现内漏复发。1例患者术后6个月因胸降主动脉瘤接受胸主动脉瘤腔内修复术;无其他主动脉相关二次手术或主动脉相关死亡。结论瘤颈捆扎治疗腹主动脉瘤腔内修复术后持续内漏相对微创, 可以有效消除内漏。     

复杂腹主动脉瘤腔内修复65例经验北大核心CSCD

目的探讨复杂肾下腹主动脉瘤腔内治疗的结果。方法回顾性分析2006年1月~2013年3月65例复杂肾下腹主动脉瘤腔内治疗的资料。其中腹主动脉瘤颈过短（〈2 cm）15例（23.1%）,参照肾动脉将支架向腹主动脉近侧释放;瘤颈严重成角（≥60°）28例（43.1%）,将腹主动脉拉直再释放支架;同时具有短瘤颈和严重成角10例（15.4%）;涉及双髂总动脉瘤的保留髂内动脉的处理5例（7.7%）,尽量保留一侧髂内动脉以防盆腔脏器缺血,2例分期行髂内动脉覆盖;入路动脉狭窄或者闭塞导致腔内覆膜支架的输送器到达预定位置困难5例（7.7%）;合并其他特殊病变2例（3.1%）。均采用腔内覆膜支架修复,其中进口血管支架29例（44.6%）,国产血管支架36例（55.4%）。结果手术均成功。23例（35.4%）即时内漏,其中Ⅰ型6例,Ⅱ型14例,Ⅲ型3例。无手术死亡。术后住院时间7~15 d,平均8.2 d。随访60例（92.3%）,随访时间1~8年,平均3.5年。死亡5例（8.3%）,死亡原因均与该病无关。1例半年后支架移位,内漏,再次行腔内修复,置延长段支架后内漏消失,继续随访22个月,支架形态和位置良好,无支架移位和内漏发生。其他内漏均消失。左下肢缺血3例,原因为1例左侧髂分支支架移位导致闭塞,行股-股动脉耻骨上人工血管旁路移植后下肢缺血症状缓解,2例髂动脉打折,再次腔内治疗放置裸支架后缺血症状缓解。结论随着腔内技术的发展和腔内治疗器材的不断完善,过去认为不能采用腔内治疗的复杂腹主动脉瘤也可以采用腔内治疗,对于复杂肾下腹主动脉瘤,腔内治疗可以获得较为满意的中远期疗效。     

复杂腹主动脉瘤腔内修复65例经验

目的探讨复杂肾下腹主动脉瘤腔内治疗的结果。方法回顾性分析2006年1月~2013年3月65例复杂肾下腹主动脉瘤腔内治疗的资料。其中腹主动脉瘤颈过短(2 cm)15例(23.1%),参照肾动脉将支架向腹主动脉近侧释放;瘤颈严重成角(≥60°)28例(43.1%),将腹主动脉拉直再释放支架;同时具有短瘤颈和严重成角10例(15.4%);涉及双髂总动脉瘤的保留髂内动脉的处理5例(7.7%),尽量保留一侧髂内动脉以防盆腔脏器缺血,2例分期行髂内动脉覆盖;入路动脉狭窄或者闭塞导致腔内覆膜支架的输送器到达预定位置困难5例(7.7%);合并其他特殊病变2例(3.1%)。均采用腔内覆膜支架修复,其中进口血管支架29例(44.6%),国产血管支架36例(55.4%)。结果手术均成功。23例(35.4%)即时内漏,其中Ⅰ型6例,Ⅱ型14例,Ⅲ型3例。无手术死亡。术后住院时间7~15 d,平均8.2 d。随访60例(92.3%),随访时间1~8年,平均3.5年。死亡5例(8.3%),死亡原因均与该病无关。1例半年后支架移位,内漏,再次行腔内修复,置延长段支架后内漏消失,继续随访22个月,支架形态和位置良好,无支架移位和内漏发生。其他内漏均消失。左下肢缺血3例,原因为1例左侧髂分支支架移位导致闭塞,行股-股动脉耻骨上人工血管旁路移植后下肢缺血症状缓解,2例髂动脉打折,再次腔内治疗放置裸支架后缺血症状缓解。结论随着腔内技术的发展和腔内治疗器材的不断完善,过去认为不能采用腔内治疗的复杂腹主动脉瘤也可以采用腔内治疗,对于复杂肾下腹主动脉瘤,腔内治疗可以获得较为满意的中远期疗效。     

肾下腹主动脉瘤的治疗

目的 探讨腹主动脉瘤手术的外科及腔内介入治疗方法，以提高其安全性。方法 回顾性分析1981年1月～2004年12月收治的肾下腹主动脉瘤患者195例，其中男155例，女40例。年龄35～80岁，平均56．5岁。瘤体直径〉5cm者183例，4～5cm者12例。动脉瘤破裂行急诊手术者20例；择期手术175例，其中行开腹动脉瘤切除及人工血管置换术139例，行血管腔内修复术36例。结果 择期手术和急诊手术于术后30d内分别死亡6例；余均获随访1个月～21年，平均8．7年，死亡16例，与血管手术有关的5例。腔内修复术中无手术死亡病例。发生内漏8例，其中Ⅰ型5例，Ⅱ型3例；6个月后CT检查：自行愈合6例，未愈合2例，但动脉瘤腔增大。迟发内漏1例，为Ⅱ型内漏，行介入栓塞后愈合。结论 随着血管外科手术技术的不断改进和血管腔内修复技术的开展，腹主动脉瘤手术的安全性将会不断提高。     

破裂腹主动脉瘤的外科治疗

目的探讨急诊腹主动脉瘤切除人工血管移植术治疗破裂腹主动脉瘤的经验。方法总结1999年4月至2005年4月外科手术治疗破裂腹主动脉瘤20例，采用钳夹阻断膈下腹主动脉或Foley氏球囊管腔内阻断瘤颈上腹主动脉后行急诊腹主动脉瘤切除人工血管移植术，应用分叉型人工血管12例，直型人工血管8例。结果急诊腹主动脉瘤切除人工血管移植手术30d围手术期死亡率40％（8例），死亡原因包括急性肾功能衰竭4例，多器官功能衰竭2例，呼吸循环衰竭2例。存活12例，术后合并症包括急性肾功能不全、肺部感染、凝血机制障碍和腹泻等共11例，均经治疗后痊愈。随访观察6～60个月，无人工血管血栓形成和感染等并发症以及随访期死亡发生。结论破裂腹主动脉瘤外科手术治疗死亡率仍然很高，早期确定诊断，紧急外科手术治疗，术后加强围手术期管理是降低破裂腹主动脉瘤死亡率的关键。     

肾动脉下腹主动脉瘤腔内治疗后并发症的防治

目的　总结肾动脉下腹主动脉瘤腔内治疗后常见并发症的预防与处理。　方法对已施行腔内治疗的 71例肾下腹主动脉瘤患者的临床资料进行回顾性分析 ,讨论常见并发症发生的原因、处理、结果及预后。　结果　 71例接受腔内治疗的肾动脉下腹主动脉瘤患者技术成功率1 0 0 % ,无中转开腹手术者。原发性内漏 8例 ,神经并发症合并急性血栓形成 1例。一过性缺血性肠炎 2例。无肾动脉梗死、肢体栓塞等并发症。平均随访时间 (2 6± 5)个月。围手术期病死率 1 3 % (1 /71 ) ,总病死率 4 2 % (3/ 71 )。死亡原因 2例为急性心肌梗死 ,1例为急性心功能衰竭。随访过程中发现 3例原发性内漏转为持续性内漏 ,另发现继发性内漏 4例。本组患者 1个月后内漏发生率 9 8%(7/ 71 )。 2例继发性Ⅰ型内漏随访中瘤体增大 ,1例进行二期腔内治疗。　结论　动脉瘤的腔内治疗具有创伤小、技术操作可行、效果肯定的优点 ,内漏血是该技术主要并发症。对漏血量及瘤体有增大趋势的内漏应积极处理     

应用国产整体式分叉型支架腔内治疗肾下型腹主动脉瘤

目的探讨应用国产整体式分叉型支架腔内治疗肾下型腹主动脉瘤的效果。方法回顾性分析2009年9月—2011年6月采用国产整体式分叉型支架腔内隔绝术治疗27例肾下型腹主动脉瘤患者的临床资料。结果 27例腹主动脉瘤腔内修复均获成功,术后随访2～20个月复查CTA,DSA证实:瘤体被完全隔绝,支架无移位、扭曲及内漏现象。结论应用国产整体式分叉型支架腔内治疗肾下型腹主动脉瘤安全有效,与分体式支架相比,其简便、经济、并发症少。     

Endovascular Treatment of Failed Prior Abdominal Aortic Aneurysm Repair

Failure of endovascular or conventional abdominal aortic aneurysm (AAA) repair may occur as a result of attachment site endoleak (type I) or paraanastomotic aneurysm and pseudoaneurysm formation. This study examined the results of the use of secondary endovascular grafts for the treatment of failed prior infrarenal AAA repair procedures. Forty-seven patients were treated with endovascular grafts. These included 14 patients with type I endoleaks (5 proximal, 8 distal, 1 proximal and distal) and 33 patients with paraanastomotic aneurysms after standard open surgical AAA repair (3 proximal aorta, 5 distal aorta, 21 iliac, 4 proximal and distal). The interval between the primary aortic procedure and the endovascular repair was significantly shorter for failed endovascular procedures (mean, 18.2 months; range, 1-42 months) than for failed conventional procedures (mean, 108.9 months; range, 12-216 months) (p <0.01). The endovascular devices used for correction of the failed AAA repairs were Talent (23), physician-made (19), AneuRx (2), Vanguard (2), and Excluder (1). Transrenal fixation was used for repair of all proximal anastomotic failures. Mean follow-up after reintervention was 12.2 months in patients with failed endovascular grafts and 10.6 months in patients with failed conventional grafts. Patient demographics were as follows: average age, 78 years; 36 male and 11 female; and 4.1 comorbid medical conditions per patient. The endovascular graft was successfully deployed in all 47 cases; 1 patient experienced a persistent proximal attachment site endoleak after endograft deployment. Endovascular grafts may be used to treat previously failed endovascular and conventional AAA repair procedures with good short- and intermediate-term results. Endovascular treatments in these cases may avoid the difficulties of aortic reoperation or AAA repair in the setting of prior endovascular aortic grafting.     

肾下腹主动脉瘤105例腔内修复的早中期疗效

目的 评估肾下腹主动脉瘤腔内修复治疗的早中期疗效.方法 回顾分析2001年1月至2007年2月105例肾下腹主动脉瘤行腔内修复治疗的经过、结果和并发症.结果 所有患者均获技术成功,82例(78.09%)获随访,随访时间1～73个月,平均(8.9 4±5.8)个月.围手术期死亡3例(2.86%),分别死于急性心肌梗死、多系统器官功能衰竭和上消化道大出血.1例(1.21%)术后30个月死于肝癌.原发性内漏21例:Ⅰ型18例,其中10例行球囊扩张(9例)或延伸段植入(1例)后治愈,8例自愈;2例Ⅱ型内漏自愈;1例Ⅲ型内漏支架植入后治愈.1例于术后2周支架的一侧髂支血栓形成,急诊行股-股动脉人工血管旁路术.4例迟发性Ⅰ型内漏.随访观察.1例于术后6年支架向远心端移位,无明显内漏而随访观察.2例支架感染发生于术后1和3个月,行清创引流和抗感染治疗后痊愈.随访期间,9例股-股或髂-股动脉旁路和3例髂内动脉旁路通畅.结论 腔内修复治疗肾下腹主动脉瘤安全、有效,早、中期疗效较好.     

An analysis of standard open and endovascular surgical repair of abdominal aortic aneurysms in octogenarians

While elective open abdominal aortic aneurysm (AAA) repair has been shown to be safe in selected octogenarians, very little is known about the role of endovascular AAA exclusion in this high-risk cohort. A retrospective review of our vascular surgical registry from January 1996 to December 2001 revealed 51 octogenarians that underwent infrarenal AAA repair. Since 1999 all octogenarians who presented for AAA repair were evaluated for preferential endovascular stent graft placement. Over the 6-year period, 35 patients underwent standard open repair while 16 patients were found to be anatomic candidates for and were treated with an endovascular stent graft. Hospital and office charts were reviewed to compare the endovascular cohort to the standard open cohort. Factors considered included patient comorbidities, perioperative data, and operative outcomes. Statistical analysis was done using Wilcoxon rank sum test and Fisher exact test. The median age for the entire group was 83 years. There were 11 females in the open group and 1 female in the endovascular group. There were no statistically significant differences in preoperative patient comorbidities between groups. Total mortality for the entire series was 11.8 per cent but this included 5 ruptured AAAs, all of which patients died, and 11 additional AAAs that were symptomatic, of which 1 patient died. Total nonruptured mortality for the entire series was 2.2 per cent (0% for the endo-group and 3.3% for the open group). There were statistically significant differences between the endovascular versus the open groups when comparing aneurysm diameter (5.6 cm vs. 6.2 cm; P = 0.016), estimated blood loss (225 cc vs. 2100 cc; P < 0.001), ICU days (0 vs. 3; P < 0.001), length of hospital stay (2 days vs. 12 days; P < 0.001), and patients with blood transfusions (1 vs. 27; P < 0.001). When comparing postoperative morbidities, 4 of the endovascular patients (25%) and 25 of the open patients (68.6%) had a complication (P = 0.006). In conclusion, endovascular stent graft treatment of nonruptured infrarenal AAAs in octogenarians led to significantly better outcomes and should probably be considered the preferred treatment whenever anatomically appropriate. Endovascular exclusion of ruptured AAAs may potentially improve future outcomes in this high-risk group.     

Zenith AAA endovascular graft: intermediate-term results of the US multicenter trial

PURPOSE: The intent of this study was to assess the safety and effectiveness of the Zenith AAA Endovascular Graft compared with conventional aneurysm repair. MATERIAL AND METHODS: The study was conducted in a prospective, multicenter, nonrandomized, concurrent control manner. Physiologically similar patients with infrarenal abdominal aortic aneurysms (AAAs) underwent either open surgery or repair with the Zenith AAA Endovascular Graft. Separate analyses of physiologically challenged patients were performed. Follow-up was conducted at hospital discharge and at 1, 6, and 12 months (endovascular repair group) or 1 and 12 months (open surgical repair group). Evaluation included computed tomography, abdominal radiography, laboratory tests, and physical examination. Mortality (AAA-related and overall), morbidity, in-hospital recovery, renal function, and secondary interventions were assessed. Patients in the endovascular repair group were evaluated for change in aneurysm size, endoleak, graft migration, conversion, rupture, and device integrity. Statistical analyses were performed with the Kaplan-Meier method, Blackwelder test, propensity score assessment, two-sample t test, Yates-corrected Pearson chi(2) test, and Fisher exact test. RESULTS: Conventional open surgery was used in 80 patients, and 200 patients underwent repair with the Zenith AAA Endovascular Graft. Technical success was accomplished in 98.8% of patients in the open repair group and 99.5% in the endovascular repair group. Patients in the endovascular repair group had fewer significant adverse events within 30 days (80% vs 57%; P <.001). All-cause mortality was similar (endovascular, 3.5%; open surgery, 3.8%). Aneurysm-related mortality was higher with conventional surgery at 12 months (3.8% vs 0.5%; P =.04). In-hospital recovery and procedural measures were better for endovascular repair in all categories (P <.001). The incidence of endoleak was 17% at 30 days, 7.4% at 12 months, and 5.4% at 24 months. Aneurysm shrinkage (>5 mm) was noted in more than two thirds of patients at 12 months and three fourths of patients at 24 months. Renal dysfunction rate did not differ between groups. Migration (>5 mm) was detected in four (2%) patients through 12 months; none was greater than 10 mm or associated with adverse events through 24 months. Three conversions were performed within 12 months, one because of aneurysm rupture. Secondary procedures were more common in the endovascular group (11% vs 2.5%; P =.03). In total, 351 patients had endografts implanted, and 6 patients were noted to have barb separations through 12-month follow-up. No stent fractures were noted. CONCLUSIONS: The Zenith AAA Endovascular Graft is safe and effective for treatment of infrarenal AAAs. The high likelihood of decrease in aneurysm size provides evidence that treatment of aneurysms with this device reverses the natural history of aneurysmal disease. The importance of long-term follow-up is underscored by the small but defined incidence of barb separation and the potential for unforeseen failure modes.     

Evaluation of the effect of endovascular options on infrarenal abdominal aortic aneurysm repair

Endovascular devices designed to exclude flow to infrarenal abdominal aortic aneurysms (AAA) were approved by the Food and Drug Administration in the United States in 1999. This action allowed widespread use of this technology for AAA exclusion. The purpose of this report is to examine trends for use of these modalities, rates of rupture of AAA, and to compare results of open AAA repair with endovascular repair. Results were collected for all hospitals, except for Veterans Administration hospitals, by a state-wide repository. Data for the years 1996 through 1998 and 2001 through 2002 were evaluated, and data from 1999 through 2000 were excluded because no separate codes were available to distinguish between open and endovascular repair. The information gathered is based on the All Patient Refined Diagnostic Related Group (APRDRG; 3M, St. Paul, MN). An average of 718 open, elective AAA was performed between 1996 and 1998. This dropped to 503 open repairs from 2001 to 2002 (P < 0.005). During that same interval, 308 endovascular elective AAA repairs were performed, therefore the total rate of elective repair increased by 100. The average rate of ruptured AAA repairs from 1996 to 1998 was 121 per year, and this dropped to 89 from 2001 to 2002 (P < 0.005). The mortality of open AAA repair during the 1996 to 1998 and 2001 to 2002 intervals was unchanged (4.7%). Mortality from endovascular AAA repair between 2001 and 2002 was 1.9 per cent (P = 0.003). Major morbidity was 14.5 per cent for open, elective AAA repair and 6.3 per cent for endovascular elective repair from 2001 to 2002 (P < 0.001). These data suggest that the advent of endovascular AAA repair has contributed to a reduction in the rate of ruptured AAA repairs, an increase in total procedures performed, and a significant decrease in perioperative deaths and major complications when compared with open AAA repair.     

Endovascular Repair of a ruptured abdominal aortic and iliac artery aneurysm with an acute iliocaval fistula secondary to lymphoma

Abdominal aortic aneurysms (AAA) are common and generally asymptomatic unless rupture occurs. A 3 to 4-cm AAA has a 1-2% risk of rupture over 5 years. We present the case of an 85-year-old male with a history of chronic lymphocytic leukemia, a 3-cm infrarenal AAA, and a 2-cm right common iliac artery aneurysm whose AAA ruptured and who developed an acute iliac artery–to–vena cava fistula secondary to eroding adenopathy from an aggressive low-grade lymphoma. Initially, an open repair was attempted but access to the aorta was not possible because of complete encasement of the infrarenal and suprarenal aorta with tumor that was clinically invading the aortic wall. Secondary tumor invasion into the aorta is a rare complication. An endovascular repair was accomplished with successful exclusion of both the aneurysm and the iliocaval fistula. Endovascular repair provides a valuable alternative in the "hostile abdomen" when standard open repair may be hazardous or impossible.     

Conformational changes associated with proximal seal zone failure in abdominal aortic endografts

OBJECTIVE: Endovascular aneurysm repair (EVAR) has become a popular treatment for abdominal aortic aneurysm (AAA). This study examines conformational changes in the infrarenal aortas of patients in whom proximal seal zone failures (PSF) developed after EVAR. METHODS: All 189 patients with aortic endograft underwent routine post-EVAR computed tomographic scan surveillance. Patients identified with proximal type I endoleaks, type III endoleaks, or proximal component separation without demonstrable endoleak underwent three-dimensional reconstruction of the computed tomographic scans from which measurements of the migration, length, volume, and angulation of the infrarenal aorta were made. RESULTS: Five patients (3%) had PSF develop, four of whom had aortic extender cuffs. Although changes in the AAA volume and aortic neck angle were slight or variable, the mean AAA length increased 34 mm and the mean aortic body angulation increased 17 degrees (P =.03 and.01, respectively). Lengthening and migration caused proximal component separation in four patients, with concomitant migration in two patients. Two patients underwent endovascular repair, two patients needed explantation of the endograft, and one patient awaits endovascular repair. Proximal component separation and type III endoleak recurred in one patient and were repaired with a custom-fitted graft. CONCLUSION: PSF of aortic endografts is associated with proximal angulation and lengthening of the infrarenal aorta. These findings reinforce the importance of proper initial deployment to minimize the need for aortic extender cuffs, which pose a risk of late endoleak development.