Background The treatment of aortic aneurysms with endovascularstents or stent–graft prostheses is receiving increasingattention as an alternative to major abdominal surgery. To definethe clinical value of this technique, we prospectively studiedthe use of stent–graft endoprostheses made of nitinoland covered with polyester fabric for the treatment of infrarenalabdominal aortic aneurysms.
Methods We treated a total of 154 patients at three academichospitals. Twenty-one patients with aortic aneurysms not involvingthe aortic bifurcation received straight stent–grafts,and 133 patients with aortic aneurysms involving the bifurcationand the common iliac arteries received bifurcated stent–grafts.After a unilateral surgical arteriotomy, the endoprostheseswere advanced through the femoral arteries and placed underfluoroscopic guidance. Computed tomography and intraarterialangiography were performed during an average follow-up of 12.5months.
Results The primary success rate, defined as complete exclusionof the abdominal aortic aneurysm from the circulation, was 86percent in the group receiving straight grafts and 87 percentin the group receiving bifurcated grafts. In three patientsthe procedure had to be converted to an open surgical operation.Minor (n = 13) or major (n = 3) complications associated withthe procedure (including 1 death) occurred in 10 percent ofthe patients. All patients had a postimplantation syndrome,with leukocytosis and elevated C-reactive protein levels.
Conclusions Our results suggest that endovascular treatmentof infrarenal abdominal aortic aneurysms is technically feasibleand can effectively exclude abdominal aortic aneurysms fromthe circulation. With further refinement, endoluminal repairmay emerge as an interventional strategy to treat infrarenalaortic aneurysms, especially in patients at high surgical risk.
Source Information
From the Departments of Diagnostic Radiology (U.B., M.L.) and Cardiovascular Surgery (F.B., G.S.), University Hospital, Freiburg, Germany; the Departments of Radiology (G.V., D.T.) and Surgery (G.N.), Henriettenstiftung, Hannover, Germany; and the Departments of Angiography and Interventional Radiology (J.L., S.T.) and Vascular Surgery (G.K., P.P., T.H.), University Hospital, Vienna, Austria.
Address reprint requests to Dr. Blum at the Department of Diagnostic Radiology, University Hospital Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany.
Infrarenal Aortic Aneurysms
Matsumura J. S., Pearce W. H., Yusuf S. W., Wenham P., Hopkinson B. R., Hoch R. C., Blum U., Beyersdorf F., Ernst C. B.
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N Engl J Med 1997;
336:1756-1758, Jun 12, 1997.
Correspondence
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