Aorto-Uni-Iliac Stent Grafts with and without Crossover Femorofemoral Bypass for Treatment of Abdominal Aortic Aneurysms: A Parallel Observational Comparative Study.

Mohammed Elkassaby,Wael A Tawfick,Sherif Sultan,Mohamed Zaki Ali,Mahmoud Alawy

doi:10.1155/2015/962078

Mohammed Elkassaby, Wael A Tawfick + Show 3 more

Open Access

https://doi.org/10.1155/2015/962078

Copy DOI

Abstract

We investigated the safety and efficacy of primary aorto-uni-iliac (AUI) endovascular aortic repair (EVAR) without fem-fem crossover in patients with abdominal aortic aneurysm (AAA) and concomitant aortoiliac occlusive disease. 537 EVARs were implemented between 2002 and 2015 in University Hospital Galway, a tertiary referral center for aortic surgery and EVAR. We executed a parallel observational comparative study between 34 patients with AUI with femorofemoral crossover (group A) and six patients treated with AUI but without the crossover (group B). Group B patients presented with infrarenal AAAs with associated total occlusion of one iliac axis and high comorbidities. Technical success was 97% (n = 33) in group A and 85% (n = 5) in group B (P = 0.31). Primary and assisted clinical success at 24 months were 88% (n = 30) and 12% (n = 4), respectively, in group A, and 85% (n = 5) and 15% (n = 1), respectively, in group B (P = 0.125). Reintervention rate was 10% (n = 3) in group A and 0% in group B (P = 0.084). No incidence of postoperative critical lower limb ischemia or amputations occurred in the follow-up period. AUI without crossover bypass is a viable option in selected cases.

Highlights

Endovascular aortic aneurysm repair (EVAR) is currently an established safe and effective option for management of both elective abdominal aortic aneurysm (AAA) and ruptured abdominal aortic aneurysms.There are many cases where endografting with bifurcated endoprosthesis is contraindicated due to anatomical restrictions, such as narrow terminal aorta and tortuous and narrow or calcified contralateral iliac artery [1, 2]
We report the feasibility of management of AAA in unfit patients, with aorto-uni-iliac endograft (AUI) devices, without the need for femorofemoral bypass
The bifurcated configuration of the endografts represents 497 (92%) cases of the total number, while the aorto-uni-iliac configuration represents 40 (7.4%) cases, of which 34 cases where done with femorofemoral crossover bypass (12 emergencies) and six cases where done without the femorofemoral crossover bypass (3 emergencies)

Summary

Introduction

There are many cases where endografting with bifurcated endoprosthesis is contraindicated due to anatomical restrictions, such as narrow terminal aorta and tortuous and narrow or calcified contralateral iliac artery [1, 2]. Recent studies confirm that AUI devices with occlusion of contralateral iliac artery and crossover femoral-femoral bypass have similar results as the treatment with bifurcated devices in selected patients [5]. This option is limited in daily practice for the treatment of AAA in fit patients. It can be more convenient in cases of high-risk patients with complex iliac anatomy, r-AAAs, or redo surgery for failed grafts [5, 6]

Methods

Results

Discussion

Conclusion