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Endovascular grafts for noninfected aortoiliac anastomotic aneurysms

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1 Endovascular grafts for noninfected aortoiliac anastomotic aneurysms
John G. Yuan, MD, Michael L. Marin, MD, Frank J. Veith, MD, Takao Ohki, MD, Luis A. Sanchez, MD, William D. Suggs, MD, Jacob Cynamon, MD, Ross T. Lyon, MD  Journal of Vascular Surgery  Volume 26, Issue 2, Pages (August 1997) DOI: /S (97) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

2 Fig. 1 Top, Aortoiliac endovascular graft consisting of an 8 mm PTFE graft predilated at its proximal aortic end to accommodate the aortic diameter. Middle, Iliac endovascular graft constructed from balloon-expandable stent (S) and 6 mm PTFE graft (G). Bottom, Occluding stent comprised of Palmaz stent sutured to 6 mm PTFE graft. Distal end of this graft protrudes like a “wind sock” (solid arrow). Purse-string suture is applied to occlude the end of the graft (open arrow). Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

3 Fig. 2 Top, Endovascular introducer/delivery system composed of endovascular graft (G) coaxially mounted on balloon catheter and packaged within introducer sheath that is fashioned with lead balloon tip (T) and a proximal hemostatic valve (V). P, pressurization valve. Bottom, Inflation of the lead balloon (T) forms a tapered tip (solid arrow) and also creates a closed sheath system allowing pressurization of the sheath, which will permit a tradeoff between pushability and flexibility of the sheath (open arrow). Reprinted with permission from Marin ML, Veith FJ, Sanchez LA, et al. World J Surg 1996;20: Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

4 Fig. 3 A, Iliac false anastomotic aneurysm (F) and true anastomotic aneurysm (T). B, Anastomotic aneurysms that occurred at proximal aortic anastomosis (p), distal anastomosis (inset), and right common iliac artery (c). Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

5 Fig. 4 Techniques A, B, and C used for endovascular repair of aortoiliac anastomotic aneurysms (see “Operative technique” section). Inset demonstrates endoluminal hand-sewn anastomosis through femoral arteriotomy. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

6 Fig. 5 A, Arteriogram demonstrates anastomotic aneurysm at proximal anastomosis of previous aortic graft. B, Contrast-enhanced CT scan shows aortic anastomotic aneurysm with leakage of contrast outside previous aortic graft. C, After endovascular repair anastomotic aneurysm is completely excluded, with no contrast seen outside endovascular graft. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

7 Fig. 5 A, Arteriogram demonstrates anastomotic aneurysm at proximal anastomosis of previous aortic graft. B, Contrast-enhanced CT scan shows aortic anastomotic aneurysm with leakage of contrast outside previous aortic graft. C, After endovascular repair anastomotic aneurysm is completely excluded, with no contrast seen outside endovascular graft. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

8 Fig. 5 A, Arteriogram demonstrates anastomotic aneurysm at proximal anastomosis of previous aortic graft. B, Contrast-enhanced CT scan shows aortic anastomotic aneurysm with leakage of contrast outside previous aortic graft. C, After endovascular repair anastomotic aneurysm is completely excluded, with no contrast seen outside endovascular graft. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

9 Fig. 6 Preoperative and postoperative CT scans demonstrate (A1) sigmoid mass (closed arrow) and colovesicula fistula as evidenced by air within bladder (open arrow). A2, A 4.9 cm aneurysm distal to left limb of previous aortobiiliac graft was also present (closed arrow). A3, Postoperative CT scan after endovascular repair demonstrates functional exclusion of aneurysm, with no contrast seen outside endovascular graft (open arrow).Preoperative arteriogram at the time of original aortic procedure 9 years before presentation (B1) and preoperative arteriogram just before endovascular repair demonstrates enlargement of left iliac anastomotic aneurysm (B2). Intraoperative arteriograms before (C1) and after (C2) endovascular repair with complete exclusion of aneurysm. Note multiple coils used to thrombose hypogastric branches (arrow). Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

10 Fig. 6 Preoperative and postoperative CT scans demonstrate (A1) sigmoid mass (closed arrow) and colovesicula fistula as evidenced by air within bladder (open arrow). A2, A 4.9 cm aneurysm distal to left limb of previous aortobiiliac graft was also present (closed arrow). A3, Postoperative CT scan after endovascular repair demonstrates functional exclusion of aneurysm, with no contrast seen outside endovascular graft (open arrow).Preoperative arteriogram at the time of original aortic procedure 9 years before presentation (B1) and preoperative arteriogram just before endovascular repair demonstrates enlargement of left iliac anastomotic aneurysm (B2). Intraoperative arteriograms before (C1) and after (C2) endovascular repair with complete exclusion of aneurysm. Note multiple coils used to thrombose hypogastric branches (arrow). Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

11 Fig. 6 Preoperative and postoperative CT scans demonstrate (A1) sigmoid mass (closed arrow) and colovesicula fistula as evidenced by air within bladder (open arrow). A2, A 4.9 cm aneurysm distal to left limb of previous aortobiiliac graft was also present (closed arrow). A3, Postoperative CT scan after endovascular repair demonstrates functional exclusion of aneurysm, with no contrast seen outside endovascular graft (open arrow).Preoperative arteriogram at the time of original aortic procedure 9 years before presentation (B1) and preoperative arteriogram just before endovascular repair demonstrates enlargement of left iliac anastomotic aneurysm (B2). Intraoperative arteriograms before (C1) and after (C2) endovascular repair with complete exclusion of aneurysm. Note multiple coils used to thrombose hypogastric branches (arrow). Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

12 Fig. 6 Preoperative and postoperative CT scans demonstrate (A1) sigmoid mass (closed arrow) and colovesicula fistula as evidenced by air within bladder (open arrow). A2, A 4.9 cm aneurysm distal to left limb of previous aortobiiliac graft was also present (closed arrow). A3, Postoperative CT scan after endovascular repair demonstrates functional exclusion of aneurysm, with no contrast seen outside endovascular graft (open arrow).Preoperative arteriogram at the time of original aortic procedure 9 years before presentation (B1) and preoperative arteriogram just before endovascular repair demonstrates enlargement of left iliac anastomotic aneurysm (B2). Intraoperative arteriograms before (C1) and after (C2) endovascular repair with complete exclusion of aneurysm. Note multiple coils used to thrombose hypogastric branches (arrow). Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

13 Fig. 6 Preoperative and postoperative CT scans demonstrate (A1) sigmoid mass (closed arrow) and colovesicula fistula as evidenced by air within bladder (open arrow). A2, A 4.9 cm aneurysm distal to left limb of previous aortobiiliac graft was also present (closed arrow). A3, Postoperative CT scan after endovascular repair demonstrates functional exclusion of aneurysm, with no contrast seen outside endovascular graft (open arrow).Preoperative arteriogram at the time of original aortic procedure 9 years before presentation (B1) and preoperative arteriogram just before endovascular repair demonstrates enlargement of left iliac anastomotic aneurysm (B2). Intraoperative arteriograms before (C1) and after (C2) endovascular repair with complete exclusion of aneurysm. Note multiple coils used to thrombose hypogastric branches (arrow). Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

14 Fig. 6 Preoperative and postoperative CT scans demonstrate (A1) sigmoid mass (closed arrow) and colovesicula fistula as evidenced by air within bladder (open arrow). A2, A 4.9 cm aneurysm distal to left limb of previous aortobiiliac graft was also present (closed arrow). A3, Postoperative CT scan after endovascular repair demonstrates functional exclusion of aneurysm, with no contrast seen outside endovascular graft (open arrow).Preoperative arteriogram at the time of original aortic procedure 9 years before presentation (B1) and preoperative arteriogram just before endovascular repair demonstrates enlargement of left iliac anastomotic aneurysm (B2). Intraoperative arteriograms before (C1) and after (C2) endovascular repair with complete exclusion of aneurysm. Note multiple coils used to thrombose hypogastric branches (arrow). Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

15 Fig. 6 Preoperative and postoperative CT scans demonstrate (A1) sigmoid mass (closed arrow) and colovesicula fistula as evidenced by air within bladder (open arrow). A2, A 4.9 cm aneurysm distal to left limb of previous aortobiiliac graft was also present (closed arrow). A3, Postoperative CT scan after endovascular repair demonstrates functional exclusion of aneurysm, with no contrast seen outside endovascular graft (open arrow).Preoperative arteriogram at the time of original aortic procedure 9 years before presentation (B1) and preoperative arteriogram just before endovascular repair demonstrates enlargement of left iliac anastomotic aneurysm (B2). Intraoperative arteriograms before (C1) and after (C2) endovascular repair with complete exclusion of aneurysm. Note multiple coils used to thrombose hypogastric branches (arrow). Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

16 Fig. 7 A1, Preoperative arteriogram shows anastomotic aneurysm at anastomosis of left limb of previous aortobiiliac graft with total occlusion of right limb. A2, Completion arteriogram confirms complete isolation of aneurysm from circulation. Left-to-right femorofemoral bypass grafting completed reconstruction. B1, Preoperative CT scan demonstrates 4.0 cm anastomotic aneurysm at anastomosis of left limb of previous aortobiiliac graft. B2, After endovascular repair, aneurysm is completely excluded from circulation, as indicated by contrast confinement to endovascular graft. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

17 Fig. 7 A1, Preoperative arteriogram shows anastomotic aneurysm at anastomosis of left limb of previous aortobiiliac graft with total occlusion of right limb. A2, Completion arteriogram confirms complete isolation of aneurysm from circulation. Left-to-right femorofemoral bypass grafting completed reconstruction. B1, Preoperative CT scan demonstrates 4.0 cm anastomotic aneurysm at anastomosis of left limb of previous aortobiiliac graft. B2, After endovascular repair, aneurysm is completely excluded from circulation, as indicated by contrast confinement to endovascular graft. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

18 Fig. 7 A1, Preoperative arteriogram shows anastomotic aneurysm at anastomosis of left limb of previous aortobiiliac graft with total occlusion of right limb. A2, Completion arteriogram confirms complete isolation of aneurysm from circulation. Left-to-right femorofemoral bypass grafting completed reconstruction. B1, Preoperative CT scan demonstrates 4.0 cm anastomotic aneurysm at anastomosis of left limb of previous aortobiiliac graft. B2, After endovascular repair, aneurysm is completely excluded from circulation, as indicated by contrast confinement to endovascular graft. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

19 Fig. 7 A1, Preoperative arteriogram shows anastomotic aneurysm at anastomosis of left limb of previous aortobiiliac graft with total occlusion of right limb. A2, Completion arteriogram confirms complete isolation of aneurysm from circulation. Left-to-right femorofemoral bypass grafting completed reconstruction. B1, Preoperative CT scan demonstrates 4.0 cm anastomotic aneurysm at anastomosis of left limb of previous aortobiiliac graft. B2, After endovascular repair, aneurysm is completely excluded from circulation, as indicated by contrast confinement to endovascular graft. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

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