Endovascular treatment of iliac limb stenoses or occlusions in 31 patients treated with the ancure endograft

PURPOSE: The authors report their experience with treatment of iliac limb complications in patients treated with the Ancure endograft with Wallstents to provide additional support and thrombolysis when needed. MATERIALS AND METHODS: From February 1996 to October 1999, 88 patients were treated for abdominal aortic aneurysm with use of the Ancure endograft. Of the 88 devices used, 20 were tube grafts and the remaining 68 devices had a total of 130 iliac limbs (bifurcated, n = 62; aortoiliac, n = 6). After graft deployment, all patients underwent intraoperative aortography; since July 1997, intravascular ultrasound (IVUS) has also been used. RESULTS: Thirty-one patients (46%) required treatment of 47 (36%) limbs with Wallstents. Graft narrowing was observed in 41 limbs (27 patients) with IVUS immediately after graft deployment. All were successfully treated with placement of Wallstents. Before routine use of intraoperative IVUS, three patients presented between 2 and 6 weeks postoperatively with iliac limb thrombosis. All three limbs were successfully treated with thrombolysis and Wallstent placement to correct the underlying iliac problem. Additionally, two contralateral limbs in these three patients were also noted to have stenosis and were treated with use of Wallstents. The last patient required placement of a Wallstent to treat stenosis of surgical anastomosis of the iliac limb of an aortoiliac endograft at 3 days. All Wallstent-reinforced Ancure endografts remained patent from 1 to 36 months (mean, 14 months). CONCLUSION: After placement of an Ancure bifurcated or aortoiliac endograft, iliac limb stenosis is easily detected with use of intraoperative IVUS. Such complications can be safely corrected with Wallstent placement. Postoperative limb occlusion at the authors' institution has been eliminated with such intervention.