ABSTRACT 107

USE OF ENDOVASCULAR STENT-GRAFTS WITH INVERTED BRANCH POSITION TO REPAIR ABDOMINAL AORTIC ANEURYSMS

A.S. Bortone, S. Schena, D. D’Agostino, E. De Cillis, M. Sciascia, L. Inglese*, L. de Luca Tupputi Schinosa
Division of Cardiovascular Surgery, DETO, University of Bari and *Division of Cardiology, “S. Donato Milanese” Hospital, Milan, Italy

Background. The use of endovascular stent-grafts to repair abdominal aortic aneurisms (AAA) is now considered a worldwide reality. However, among complications, the commonest seem to be paraprosthetic leak and thrombosis of the graft branches. Branch thrombosis can be related either to kinking as a consequence of shrinking of the aneurysm or wide iliac bifurcation angles with displacement of the graft. In order to overcome these anomalies, we introduced the implantation of endovascular stent-graft with inverted branch position, thus obtaining a better blood flow from the aorta to distal arterial districts.

Methods. Seven male patients, admitted with diagnosis of AAA and angiographic evidence of wide iliac angles, underwent deployment of Excluder®-Gore (2), Talent®-Medtronic (3) and Vanguard®-Boston Scientifics (2) endovascular stent-grafts.

Results. The procedure resulted uneventful in each case and patients were discharged in good overall conditions within 5 days. During the follow-up at 3 and 6 months, based on angio-CT scan of the abdomen, each patient showed a satisfactory blood flow with complete recovery from symptoms. Moreover, an optimal sealing and morphological appearance were observed.

Comment. The introduction of endovascular stent-grafts with inverted position of the branches allows a better hemodynamic performance and prevents thrombosis of branches due to kinking in patients with diagnosis of AAA and anomalous iliac bifurcation.