Abstract
This study reports on animal experimentation and initial clinical
trials exploring the feasibility of exclusion of an abdominal aortic
aneurysm by placement of an intraluminal, stent-anchored, Dacron
prosthetic graft using retrograde cannulation of the common femoral
artery under local or regional anesthesia. Experiments showed that
when a balloon-expandable stent was sutured to the partially overlapping
ends of a tubular, knitted Dacron graft, friction seals were created
which fixed the ends of the graft to the vessel wall. This excludes
the aneurysm from circulation and allows normal flow through the
graft lumen. Initial treatment in five patients with serious co-morbidities
is described. Each patient had an individually tailored balloon diameter
and diameter and length of their Dacron graft. Standard stents were
used and the diameter of the stent-graft was determined by sonography,
computed tomography, and arteriography. In three of them a cephalic
stent was used without a distal stent. In two other patients both
ends of the Dacron tubular stent were attached to stents using a
one-third stent overlap. In these latter two, once the proximal neck
of the aneurysm was reached, the sheath was withdrawn and the cephalic
balloon inflated with a saline/contrast solution. The catheter was
gently removed caudally towards the arterial entry site in the groin
to keep tension on the graft, and the second balloon inflated so
as to deploy the second stent. Four of the five patients had heparin
reversal at the end of the procedure. We are encouraged by this early
experience, but believe that further developments and more clinical
trials are needed before this technique becomes widely used.
- abdominal,
- aged;
- aneurysm,
- animals;
- aorta,
- aortic
- arteriosclerosis,
- artery;
- balloon
- blood
- complications/radiography/surgery;
- complications;
- coronary
- design;
- dilatation,
- disease,
- diseases,
- dissecting,
- dogs;
- embolism,
- femoral
- humans;
- instrumentation;
- lung
- male;
- middle
- obstructive,
- polyethylene
- polyethylenes;
- polytetrafluoroethylene;
- prosthesis
- prosthesis;
- radiography/surgery;
- stainless
- steel;
- stents
- surgery;
- terephthalates;
- vessel
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