Abdominal aortic stent-graft

Abdominal aortic aneurysms bifurcated supported stent graft (Excluder, Gore). 

I I Wolf YG, Arko FR, Hill BB, et al. Gender differences in endovascular abdominal aortic aneurysm repair with the AneuRx stent graft. J Vase Surg 2002 35(5) 882-886. 

Berg R Kaufmann D, van Marrewijk CJ, et al. Spinal cord ischaemia after stent-graft treatment for infra-renal abdominal aortic aneurysms, Analysis of the Eurostar database, Eur J Vase Endovasc Surg 2001 22(4) 342-347. 

Cuypers P, Buth J, Harris PL,et al (1999) Realistic expectations for patients with stent-graft treatment of abdominal aortic aneurysms. Results of a European multicentre registry. Eur J Vase Endovasc Surg 17 507-516... 

Fan CM, Rafferty EA, Geller EC et al (2001) Endovascular stent-graft in abdominal aortic aneurysms The relationship between patent vessels that arise from the aneurysmal sac and early endoleak. Radiology 218 176-182... 

The final chapter of the book is focused on stent grafts that provide the currently preferred and less invasive endovascular therapy for treating thoracic and abdominal aortic aneurysms. This is a comparatively recent development that has brought interventional radiologists into the same operating room as vascular surgeons, which has led to a reappraisal of the role of each type of specialist in providing vascular therapy. Details about the materials, clinical performance, current issues and future directions are all described in Chapter 21. 

Key words stent graft, endovascular aortic repair (EVAR), abdominal aortic aneurysm (AAA), endoleak, fenestrated graft. 

Typical endovascular stent graft deployment for infrarenal abdominal aortic aneurysm. 

Bolton Medical s Treovance stent-graft for the abdominal aortic aneurysmal repair. 

Currently there is only one prefenestrated endovascular stent-graft system approved by the FDA for use in the United States. It is an iteration of the Cook Zenith called the Cook Zenith Fenestrated . It is custom-made for each patient based on their personal aortic anatomy. This requires detailed CT scans of the abdominal aorta to properly locate the renal arteries and the superior mesenteric artery. The device is then manufactured with holes in the top piece for the renal arteries and a scallop at the top for the superior mesenteric artery (Fig. 21.19). These fenestrations are usually supported by a nitinol metal ring sewn around the circumference of the fenestration, as seen in the image taken from the study by Halak et al. (2006) (Fig. 21.20). 

Moloye, O. B. Modification of an Endovascular Stent Graft for Abdominal Aortic Aneurysm [Dissertation]. University of Florida 2006. 

Rose J. (2006). Stent-grafts for unruptured abdominal aortic aneurysms current status. Cardiovasc Intervent Radiol, May-Jun 29 (3), 332-343. 

Z. Li and C. Kleinstreuer. Analysis of biomechanical factors affecting stent-graft migration in an abdominal aortic aneurysm model. J Biochem. 2006 39(12) 2264-2273. 

MSCT with M1P and VR may diagnose a traumatic or non-traumatic ruptured thoracic and abdominal aortic aneurysm on the basis of a contrast-enhanced CT scan that shows an aortic aneurysm with adjacent periaortic hemorrhage (Fig. 25.4) and may depict active bleeding, the extension of the aneurysm, the presence and extent of mural thrombosis and the stenosis or occlusion of vessels. For interventional stent repair, most of the measurements for determination of the optimal dimension and type of stent-graft are obtained with MSCT and 3D reconstructions. 

Sandmann and Pfeiffer (2002) carried out a survey of 2,030 patients after EVAR due to abdominal aortic aneurysm. Within the first 4 years, 38% of patients had to undergo reintervention due to comphcations of the stent graft. The most common comphcations are endoleaks (Fig. 23.9), with a rate of 10% after 18 months. Endoleaks are generally classified into five types ... 

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