Christopher K. Zarins, MD, Rodney A. White, MD, Thomas J. Fogarty, MD

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Presentation transcript:

Aneurysm rupture after endovascular repair using the AneuRx stent graft Christopher K. Zarins, MD, Rodney A. White, MD, Thomas J. Fogarty, MD Journal of Vascular Surgery Volume 31, Issue 5, Pages 960-970 (May 2000) DOI: 10.1067/mva.2000.106497 Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Patient 2. Explanted stent graft from aortic aneurysm, which ruptured 14 months after implantation. A , The specimen reveals tortuosity of the iliac limbs and no curvature of the stiff proximal bifurcation body. There is evidence of soft thrombus and poor stent graft incorporation at the proximal attachment site (arrow ). B, Cross sections of stent graft demonstrate that the iliac limbs and most of the bifurcation are well encased in fibrous tissue. Poor tissue ingrowth with soft thrombus is seen in the area of angulation of the neck (arrows ). This is consistent with poor proximal fixation as the cause of rupture C , Photomicrograph demonstrating the stent graft bifurcation. The nitinol stents are visible and external to the polyester graft fabric, which is well incorporated by fibrous tissue. The iliac limb is well fixed in the bifurcation gate. Journal of Vascular Surgery 2000 31, 960-970DOI: (10.1067/mva.2000.106497) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Patient 3. Abdominal radiograph demonstrating a bifurcation stent graft with a short right limb and a long left limb. The right limb barely reached the right iliac artery, and there was a large endoleak at this site. Note the proximal curvature of the bifurcation module with the segmented stent graft design of the AneuRx stent graft currently in use. Journal of Vascular Surgery 2000 31, 960-970DOI: (10.1067/mva.2000.106497) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Patient 4. Serial cross-sectional images demonstrating marked anterior angulation of infrarenal aortic aneurysm neck in patient with a 9.0-cm AAA. Journal of Vascular Surgery 2000 31, 960-970DOI: (10.1067/mva.2000.106497) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Patient 4. Decrease in aneurysm size after endovascular repair of a 9.0-cm aortic aneurysm. Aneurysm size decreased to 7.5 cm at 6 months and 5.9 cm at 12 months. Note progressive anterior displacement of the limbs of the stent graft, particularly the left limb, as the aneurysm decreased in size. Journal of Vascular Surgery 2000 31, 960-970DOI: (10.1067/mva.2000.106497) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Patient 4. Shaded surface display after implantation of three-dimensional CT reconstruction (left image ) and abdominal radiograph (right image ). The iliac junction gate markers are visible on the abdominal radiograph, and the iliac limb marker is seen at the bottom of the junction gate. Progressive aneurysm shrinkage and anterior angulation resulted in distraction and separation of the iliac limb. Journal of Vascular Surgery 2000 31, 960-970DOI: (10.1067/mva.2000.106497) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Patient 5. Three-dimensional reconstruction of spiral CT scans demonstrating (A) an accessory left renal artery arising from a 5.9-cm AAA. B, After endovascular aneurysm repair, an endoleak originating from a lumbar artery and exiting through the left accessory renal artery was demonstrated at 1 month. C, At 16 months the aneurysm had enlarged to 6.3 cm, and the endoleak now communicated with the left iliac artery attachment site. The patient refused recommended surgical repair. D, The aneurysm ruptured at 24 months, at which time the endoleak was larger at the iliac artery attachment. Journal of Vascular Surgery 2000 31, 960-970DOI: (10.1067/mva.2000.106497) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Patient 6. Three-dimensional reconstruction of contrast CT scan at time of aneurysm rupture 3 weeks after stent graft placement low in angulated infrarenal neck. A large proximal endoleak is demonstrated with poor fixation to the infrarenal neck. Journal of Vascular Surgery 2000 31, 960-970DOI: (10.1067/mva.2000.106497) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 8 Probability of no aneurysm rupture: Kaplan-Meier Life Table Analysis. Journal of Vascular Surgery 2000 31, 960-970DOI: (10.1067/mva.2000.106497) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions