Early Experience with the Sydney and EVT Prostheses for Endoluminal Treatment of Abdominal Aortic Aneurysms

Abstract

Purpose:

The aim of this study was to report early experiences with the Sydney and Endovascular Technologies (EVT) prostheses for the treatment of abdominal aortic aneurysms (AAA) deemed suitable for endoluminal tube graft repair.

Methods:

Consecutive endoluminal tube graft repairs were analyzed over the first 12 months in which the Sydney and EVT prostheses were used. Patients eligible for the EVT prosthesis had type I AAAs: a proximal neck length ≥ 2 cm, a distal cuff length ≥ 1.5 cm, and nontortuous iliac arteries ≥ 8 mm. Selection criteria for the Sydney device were more liberal and included AAAs that had distal cuffs < 1.5 cm. During the study period, 28 of 91 patients evaluated for AAA repair were thus selected for endoluminal grafting: 18 patients received the Sydney endograft and 10 the EVT device. Medical comorbidities were present in slightly less than one third of patients in both groups. Contrast-enhanced computerized tomography (CT) was performed preoperatively, within 10 days of operation, and at 6 and 12 months postprocedure.

Results:

All endografts were successfully deployed in both groups. Postprocedural CT scans revealed incomplete aneurysm exclusion in four patients with the Sydney endograft. Subsequent deployment of a second endograft sealed these “leaks” in two cases; the other two were converted to open repair (89% clinical success). No leaks were seen with the EVT device. Local/vascular complications occurred in 33% of the Sydney group compared with 20% for the EVT device (p = 0.001); systemic sequelae were more common in the EVT group (30% versus 17% in the Sydney cohort, p = 0.002). There were no deaths within 30 days; three late deaths were not procedure related.

Conclusion:

AAAs that are suitable for endoluminal tube graft repair may be treated with a high rate of initial success with either the Sydney or EVT prostheses. More liberal selection criteria may increase the likelihood of local/vascular complications.

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References

Parodi

Palmaz

Barone

. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991;5:491–499.

Moore

Vescera

. Repair of abdominal aortic aneurysm by transfemoral endovascular graft placement. Ann Surg 1994;220:331–341.

White

May

. Experimental endoluminal grafts and coated stents. (Abstr.) Angiology 1993;44:26–27.

White

May

. A new nonstented endoluminal graft for straight or bifurcated endoluminal bypass. J Endovasc Surg 1994;1:16–24.

White

May

. Stented and nonstented grafts for aneurysmal disease: The Sydney experience. In: Chuter

Donayre

White

, eds. Endoluminal Vascular Prostheses. Boston, Little, Brown and Company, Inc., 1995:107–152.

White

May

. Sydney experience with endoluminal grafts for the treatment of simple and complex abdominal aortic aneurysms. (Abstr.) J Endovasc Surg 1995;2:220–221.

May

White

Waugh

. Transluminal placement of a prosthetic graft-stent device for treatment of subclavian aneurysm. J Vasc Surg 1993;18:1056–1059.

May

White

. Treatment of complex abdominal aneurysms by a combination of endoluminal and extraluminal aortofemoral grafts. J Vasc Surg 1994;19:924–933.

May

White

Waugh

. Endoluminal repair of abdominal aortic aneurysm. Med J Aust 1994;161:541–543.

10.

May

White

. Endoluminal grafting of abdominal aortic aneurysms: Causes of failure and their prevention. J Endovasc Surg 1994;1:44–52.

11.

May

White

. Specialized endovascular techniques: Combined surgical and endovascular approaches. In: White

Fogarty

, eds. Peripheral Endovascular Interventions. St. Louis, Mosby Year Book, 1995; (In press).

12.

White

May

. Development of a clinical program of endoluminal aneurysm grafting: Experience in 60 patients. In: Parodi

Marin

Veith

. Endovascular Grafting Techniques. Baltimore, Williams & Wilkins, 1995; (In press).

13.

White

Stephen

. Endoluminal repair of abdominal aortic aneurysms using the double tube endograft or “trombone” technique. Asian J Surg 1995; (In press).

14.

Parodi

. Endovascular repair of abdominal aortic aneurysms. In: Chuter

Donayre

White

, eds. Endoluminal Vascular Prostheses. Boston, Little, Brown and Company, Inc., 1995:37–53.