Endovascular graft repair of ruptured aortoiliac aneurysms

Takao Ohki, Frank J. Veith, Luis A. Sanchez, Jacob Cynamon, Evan C. Lipsitz, Reese A. Wain, Jeffery A. Morgan, Lu Zhen, William D. Suggs, Ross T. Lyon

Research output: Contribution to journalArticle

136 Citations (Scopus)

Abstract

Background: The feasibility of endovascular graft (EVG) repair of ruptured aortoiliac aneurysms (AIAs) has yet to be demonstrated. There are inherent limitations in EVG repair, including the need for preoperative measurements of the aneurysmal and adjacent arterial anatomy to determine the appropriate size and type of graft and the inherent delay to obtain proximal occlusion. We developed an EVG system with broad versatility that largely eliminates these problems. Study Design: Between 1993 and 1998, within an experience of 134 endovascular AIA repairs, 12 ruptured AIAs were treated using EVGs that facilitated intraoperative customization and eliminated the need for preoperative measurements. The EVGs consisted of either a Palmaz stent and a PTFE graft deployed by a compliant balloon (n = 9) or a self- expanding covered stent graft (n = 3). Both grafts were cut to the appropriate length intraoperatively. The mean age of the patients was 72 years (range 40 to 86 years). The mean size of the aneurysms was 7.6 cm (range 3 to 16 cm). Preoperative symptoms were present in all patients and included abdominal or back pain (n = 9), syncope (n = 4), and external bleeding (n = 2). All patients were high surgical risks because of comorbid disease (n = 10) or previous abdominal operations (n = 6), and nine experienced hypotension. Results: All EVGs were inserted successfully and excluded the aneurysms from the circulation. The mean operating time was 263 minutes, the mean blood loss was 715 mL, and the mean length of hospital stay was 6.5 days. There were two deaths (16%), one from the preexisting acute myocardial infarction and one from multiple organ failure. There were three minor complications (25%). Two patients required evacuation of an intraabdominal hematoma from the initial rupture. All but one of the grafts was functioning at a mean follow-up of 18 months. Conclusions: This study demonstrates the feasibility of EVG repair for ruptured AlAs using a graft that can be customized intraoperatively for each patient. Such repairs currently are valuable in patients with ruptured AIAs and serious comorbidities and may be applicable in other circumstances as well.

Original languageEnglish (US)
Pages (from-to)102-113
Number of pages12
JournalJournal of the American College of Surgeons
Volume189
Issue number1
DOIs
StatePublished - Jul 1999

Fingerprint

Ruptured Aneurysm
Transplants
Aneurysm
Stents
Length of Stay
Multiple Organ Failure
Polytetrafluoroethylene
Syncope
Feasibility Studies
Back Pain
Hematoma
Hypotension
Abdominal Pain
Comorbidity
Rupture
Anatomy
Myocardial Infarction
Hemorrhage

ASJC Scopus subject areas

  • Surgery

Cite this

Endovascular graft repair of ruptured aortoiliac aneurysms. / Ohki, Takao; Veith, Frank J.; Sanchez, Luis A.; Cynamon, Jacob; Lipsitz, Evan C.; Wain, Reese A.; Morgan, Jeffery A.; Zhen, Lu; Suggs, William D.; Lyon, Ross T.

In: Journal of the American College of Surgeons, Vol. 189, No. 1, 07.1999, p. 102-113.

Research output: Contribution to journalArticle

Ohki, T, Veith, FJ, Sanchez, LA, Cynamon, J, Lipsitz, EC, Wain, RA, Morgan, JA, Zhen, L, Suggs, WD & Lyon, RT 1999, 'Endovascular graft repair of ruptured aortoiliac aneurysms', Journal of the American College of Surgeons, vol. 189, no. 1, pp. 102-113. https://doi.org/10.1016/S1072-7515(99)00051-4
Ohki, Takao ; Veith, Frank J. ; Sanchez, Luis A. ; Cynamon, Jacob ; Lipsitz, Evan C. ; Wain, Reese A. ; Morgan, Jeffery A. ; Zhen, Lu ; Suggs, William D. ; Lyon, Ross T. / Endovascular graft repair of ruptured aortoiliac aneurysms. In: Journal of the American College of Surgeons. 1999 ; Vol. 189, No. 1. pp. 102-113.
@article{4e9d732ab9fa4801a6f25ca0147bd17a,
title = "Endovascular graft repair of ruptured aortoiliac aneurysms",
abstract = "Background: The feasibility of endovascular graft (EVG) repair of ruptured aortoiliac aneurysms (AIAs) has yet to be demonstrated. There are inherent limitations in EVG repair, including the need for preoperative measurements of the aneurysmal and adjacent arterial anatomy to determine the appropriate size and type of graft and the inherent delay to obtain proximal occlusion. We developed an EVG system with broad versatility that largely eliminates these problems. Study Design: Between 1993 and 1998, within an experience of 134 endovascular AIA repairs, 12 ruptured AIAs were treated using EVGs that facilitated intraoperative customization and eliminated the need for preoperative measurements. The EVGs consisted of either a Palmaz stent and a PTFE graft deployed by a compliant balloon (n = 9) or a self- expanding covered stent graft (n = 3). Both grafts were cut to the appropriate length intraoperatively. The mean age of the patients was 72 years (range 40 to 86 years). The mean size of the aneurysms was 7.6 cm (range 3 to 16 cm). Preoperative symptoms were present in all patients and included abdominal or back pain (n = 9), syncope (n = 4), and external bleeding (n = 2). All patients were high surgical risks because of comorbid disease (n = 10) or previous abdominal operations (n = 6), and nine experienced hypotension. Results: All EVGs were inserted successfully and excluded the aneurysms from the circulation. The mean operating time was 263 minutes, the mean blood loss was 715 mL, and the mean length of hospital stay was 6.5 days. There were two deaths (16{\%}), one from the preexisting acute myocardial infarction and one from multiple organ failure. There were three minor complications (25{\%}). Two patients required evacuation of an intraabdominal hematoma from the initial rupture. All but one of the grafts was functioning at a mean follow-up of 18 months. Conclusions: This study demonstrates the feasibility of EVG repair for ruptured AlAs using a graft that can be customized intraoperatively for each patient. Such repairs currently are valuable in patients with ruptured AIAs and serious comorbidities and may be applicable in other circumstances as well.",
author = "Takao Ohki and Veith, {Frank J.} and Sanchez, {Luis A.} and Jacob Cynamon and Lipsitz, {Evan C.} and Wain, {Reese A.} and Morgan, {Jeffery A.} and Lu Zhen and Suggs, {William D.} and Lyon, {Ross T.}",
year = "1999",
month = "7",
doi = "10.1016/S1072-7515(99)00051-4",
language = "English (US)",
volume = "189",
pages = "102--113",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - Endovascular graft repair of ruptured aortoiliac aneurysms

AU - Ohki, Takao

AU - Veith, Frank J.

AU - Sanchez, Luis A.

AU - Cynamon, Jacob

AU - Lipsitz, Evan C.

AU - Wain, Reese A.

AU - Morgan, Jeffery A.

AU - Zhen, Lu

AU - Suggs, William D.

AU - Lyon, Ross T.

PY - 1999/7

Y1 - 1999/7

N2 - Background: The feasibility of endovascular graft (EVG) repair of ruptured aortoiliac aneurysms (AIAs) has yet to be demonstrated. There are inherent limitations in EVG repair, including the need for preoperative measurements of the aneurysmal and adjacent arterial anatomy to determine the appropriate size and type of graft and the inherent delay to obtain proximal occlusion. We developed an EVG system with broad versatility that largely eliminates these problems. Study Design: Between 1993 and 1998, within an experience of 134 endovascular AIA repairs, 12 ruptured AIAs were treated using EVGs that facilitated intraoperative customization and eliminated the need for preoperative measurements. The EVGs consisted of either a Palmaz stent and a PTFE graft deployed by a compliant balloon (n = 9) or a self- expanding covered stent graft (n = 3). Both grafts were cut to the appropriate length intraoperatively. The mean age of the patients was 72 years (range 40 to 86 years). The mean size of the aneurysms was 7.6 cm (range 3 to 16 cm). Preoperative symptoms were present in all patients and included abdominal or back pain (n = 9), syncope (n = 4), and external bleeding (n = 2). All patients were high surgical risks because of comorbid disease (n = 10) or previous abdominal operations (n = 6), and nine experienced hypotension. Results: All EVGs were inserted successfully and excluded the aneurysms from the circulation. The mean operating time was 263 minutes, the mean blood loss was 715 mL, and the mean length of hospital stay was 6.5 days. There were two deaths (16%), one from the preexisting acute myocardial infarction and one from multiple organ failure. There were three minor complications (25%). Two patients required evacuation of an intraabdominal hematoma from the initial rupture. All but one of the grafts was functioning at a mean follow-up of 18 months. Conclusions: This study demonstrates the feasibility of EVG repair for ruptured AlAs using a graft that can be customized intraoperatively for each patient. Such repairs currently are valuable in patients with ruptured AIAs and serious comorbidities and may be applicable in other circumstances as well.

AB - Background: The feasibility of endovascular graft (EVG) repair of ruptured aortoiliac aneurysms (AIAs) has yet to be demonstrated. There are inherent limitations in EVG repair, including the need for preoperative measurements of the aneurysmal and adjacent arterial anatomy to determine the appropriate size and type of graft and the inherent delay to obtain proximal occlusion. We developed an EVG system with broad versatility that largely eliminates these problems. Study Design: Between 1993 and 1998, within an experience of 134 endovascular AIA repairs, 12 ruptured AIAs were treated using EVGs that facilitated intraoperative customization and eliminated the need for preoperative measurements. The EVGs consisted of either a Palmaz stent and a PTFE graft deployed by a compliant balloon (n = 9) or a self- expanding covered stent graft (n = 3). Both grafts were cut to the appropriate length intraoperatively. The mean age of the patients was 72 years (range 40 to 86 years). The mean size of the aneurysms was 7.6 cm (range 3 to 16 cm). Preoperative symptoms were present in all patients and included abdominal or back pain (n = 9), syncope (n = 4), and external bleeding (n = 2). All patients were high surgical risks because of comorbid disease (n = 10) or previous abdominal operations (n = 6), and nine experienced hypotension. Results: All EVGs were inserted successfully and excluded the aneurysms from the circulation. The mean operating time was 263 minutes, the mean blood loss was 715 mL, and the mean length of hospital stay was 6.5 days. There were two deaths (16%), one from the preexisting acute myocardial infarction and one from multiple organ failure. There were three minor complications (25%). Two patients required evacuation of an intraabdominal hematoma from the initial rupture. All but one of the grafts was functioning at a mean follow-up of 18 months. Conclusions: This study demonstrates the feasibility of EVG repair for ruptured AlAs using a graft that can be customized intraoperatively for each patient. Such repairs currently are valuable in patients with ruptured AIAs and serious comorbidities and may be applicable in other circumstances as well.

UR - http://www.scopus.com/inward/record.url?scp=0033026239&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033026239&partnerID=8YFLogxK

U2 - 10.1016/S1072-7515(99)00051-4

DO - 10.1016/S1072-7515(99)00051-4

M3 - Article

VL - 189

SP - 102

EP - 113

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 1

ER -