Periprosthetic leak and rupture after endovascular repair of abdominal aortic aneurysm: The significance of device design for long-term results Kirsten.

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Presentation transcript:

Periprosthetic leak and rupture after endovascular repair of abdominal aortic aneurysm: The significance of device design for long-term results Kirsten Krohg-Sørensen, MD, PhD, Magne Brekke, MD, Anders Drolsum, MD, Knut Kvernebo, MD, PhD Journal of Vascular Surgery Volume 29, Issue 6, Pages 1152-1158 (June 1999) DOI: 10.1016/S0741-5214(99)70253-3 Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Preoperative angiogram (A) and completion angiogram (B) after primary treatment with Vanguard bifurcated endovascular aortic graft (Boston Scientific Corporation, Paris, France). Note proximal V-shaped marker of stent graft close to right renal artery. Journal of Vascular Surgery 1999 29, 1152-1158DOI: (10.1016/S0741-5214(99)70253-3) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Computed tomographic scans at (A) 9 months and (B) 12 months showing increased periprosthetic leak from tear in prosthesis and increased aneurysm diameter. Journal of Vascular Surgery 1999 29, 1152-1158DOI: (10.1016/S0741-5214(99)70253-3) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Angiogram at ( A) anteroposterior and (B) side view after 12 months showing periprosthetic leak caused by tear in prosthesis. On (B) side view, blood stream from tear in posterior of prosthesis can be seen. There is no sign of migration because markers of stent graft are unchanged as compared with Fig 1A. Leak was sealed with tube stent graft, and position of this inside the body of bifurcation can be seen by comparing the metal markers of B and C. Proximal marker of tube graft is on anterior of graft and in line with the most proximal marker of bifurcated stent, and distal marker of tube is on the posterior and a little proximal to markers of junction of second limb. Journal of Vascular Surgery 1999 29, 1152-1158DOI: (10.1016/S0741-5214(99)70253-3) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Computed tomographic scan 3 months after embolization of lumbar arteries with backflow. There is still small backflow from right lumbar artery through coils. Journal of Vascular Surgery 1999 29, 1152-1158DOI: (10.1016/S0741-5214(99)70253-3) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Computed tomographic scan after 20 months. Periprosthetic leak is related to connection between second limb and bifurcation. Size of aneurysm has increased to 100 mm, and there is rupture with retroperitoneal hematoma. Journal of Vascular Surgery 1999 29, 1152-1158DOI: (10.1016/S0741-5214(99)70253-3) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Explanted endovascular aortic graft. V-formed tear of polyester prosthesis was adjacent to V-formed shape of underlying nitinol wire. At this point, the suture connecting wire to more caudal zigzag wire was broken, allowing the two struts to move separately. Journal of Vascular Surgery 1999 29, 1152-1158DOI: (10.1016/S0741-5214(99)70253-3) Copyright © 1999 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions