Delayed rupture of aortic aneurysms following endovascular stent grafting

Lumsden, Alan B.; Allen, Robert C.; Chaikof, Elliot L.; Resnikoff, Michael; Moritz, Mark W.; Gerhard, Harvey; Castronuovo, John J.

« Previous Next »The American Journal of Surgery
Volume 170, Issue 2 , Pages 174-178, August 1995

Delayed rupture of aortic aneurysms following endovascular stent grafting☆

Alan B. Lumsden, MB, ChB
- Requests for reprints should be addressed to Alan B. Lumsden, MB, ChB, 1364 Clifton Road NE, Box M-11, Atlanta, Georgia 30322.
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia USA
Robert C. Allen, MD
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia USA
Elliot L. Chaikof, MD, PhD
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia USA
Michael Resnikoff, MD
- Department of Morristown Memorial Hospital, Morristown, New Jersey, USA
- Columbia University, College of Physicians and Surgeons, New York, New York, USA
Mark W. Moritz, MD
- Department of Morristown Memorial Hospital, Morristown, New Jersey, USA
- Columbia University, College of Physicians and Surgeons, New York, New York, USA
Harvey Gerhard, MD
- Department of Morristown Memorial Hospital, Morristown, New Jersey, USA
- Columbia University, College of Physicians and Surgeons, New York, New York, USA
John J. Castronuovo Jr., MD
- Department of Morristown Memorial Hospital, Morristown, New Jersey, USA
- Columbia University, College of Physicians and Surgeons, New York, New York, USA

Abstract

Background: Deployment of transfemoral, endovascular stent grafts for treatment of abdominal aortic aneurysms is appealing for several reasons: avoidance of abdominal incision, lack of aortic cross-clamping, potential for regional anesthesia, and shortened hospital stay. Concerns remain, however, regarding the ability of these devices to completely exclude the aneurysm and prevent aneurysm rupture and the long-term integrity of the device. The availability of endografts and the likely development of percutaneous devices have also raised the delicate issue of personnel training for patient selection, endograft implantation, and postoperative follow-up.

Patients and methods: The cases of 2 patients are reported in which Dacron endovascular grafts, anchored proximally and distally by Palmaz stents, were deployed for treatment of infrarenal abdominal aortic aneurysms.

Results: In a patient with an absent distal cuff, choosing this procedure represented a clear error in patient selection. The endograft failed to reach the aortic bifurcation and the aneurysm ruptured, with the death of the patient 4 months postimplantation.

In a patient with anatomy suitable for endograft placement, a perigraft leak persisted at the distal anastomosis following device palcement. The aneurysm ruptured 14 days postprocedure. Although the patient survived emergent aneurysm repair, he developed acute renal failure.

Conclusion: Careful preoperative assessment of aortic anatomy is crucial in selection of patients for transfemoral endovascular graft placement. Lack of a distal cuff of at least 1 cm precludes tube graft implantation. Patients with a perigraft leak are not protected by the endograft from aneurysm rupture. Vascular surgeons must be involved in the preoperative evaluation of these patients and are the only specialty group who can provide the prerequisite care in evaluation and management of postoperative complications.

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