Coupling bifurcated stent-grafts to overcome anatomic limitations of endovascular repair of abdominal aortic aneurysms

Myungsu Lee, Do Yun Lee, ManDeuk Kim, Kwang Hun Lee, Mu Sook Lee, Sung Il Park, Jong Yun Won, Donghoon Choi, Young Guk Ko

Research output: Contribution to journalArticle

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Abstract

Purpose: To evaluate the effectiveness of the coupling stent-graft technique and outcomes on contrast-enhanced computed tomography (CT). Materials and Methods: All patients who underwent endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) between 2007 and 2010 at a single institution were retrospectively analyzed. Of the 161 cases, 19 patients who had coupling stent-grafting because of AAA proximal neck angulation greater than 60°, conical neck, or iliac tortuosity were included. Patient age ranged from 62 to 87 years (mean, 73.3 y). Mean follow-up was 18.7 months (range, 1-36 mo). The coupling stent-graft technique was defined by the use of suprarenal fixation device main bodies (Zenith or Talent) with one or more EXCLUDER limbs to adapt tortuous and angulated iliac arteries. Pretreatment contrast-enhanced CT was analyzed based on three-dimensional and multiplanar reformatted images. Follow-up contrast-enhanced CT was also analyzed. Results: Mean aneurysm diameter was 68.9 mm ± 14.0, neck length was 32.7 mm ± 15.1, and neck angulation was 68.9° ± 11.5. Conical neck shapes were present in four patients (21.1%) and ruptured AAAs were present in two (10.5%). Among 38 iliac arteries, the mean iliac artery tortuosity index was 1.52 ± 0.27 and iliac angle was 106.8° ± 18.1. Three patients (15.8%) underwent repeat intervention: placement of a balloon-expandable stent in the proximal neck for type I endoleak (n = 1), endovascular embolization for proximal type I endoleak (n = 1), and percutaneous approach following endovascular embolization for type II endoleak (n = 1). No type III endoleak, limb occlusion, limb kinking, or stent-graft migration developed. Conclusions: The coupling stent-graft technique is technically feasible, with acceptable midterm outcomes in EVAR of AAA in patients with unfavorable neck and iliac anatomies.

Original languageEnglish
Pages (from-to)1065-1069
Number of pages5
JournalJournal of Vascular and Interventional Radiology
Volume23
Issue number8
DOIs
Publication statusPublished - 2012 Aug 1

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Abdominal Aortic Aneurysm
Stents
Endoleak
Transplants
Neck
Iliac Artery
Aneurysm
Extremities
Tomography
Aortic Rupture
Aptitude
Anatomy
Equipment and Supplies

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Lee, Myungsu ; Lee, Do Yun ; Kim, ManDeuk ; Lee, Kwang Hun ; Lee, Mu Sook ; Park, Sung Il ; Won, Jong Yun ; Choi, Donghoon ; Ko, Young Guk. / Coupling bifurcated stent-grafts to overcome anatomic limitations of endovascular repair of abdominal aortic aneurysms. In: Journal of Vascular and Interventional Radiology. 2012 ; Vol. 23, No. 8. pp. 1065-1069.
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abstract = "Purpose: To evaluate the effectiveness of the coupling stent-graft technique and outcomes on contrast-enhanced computed tomography (CT). Materials and Methods: All patients who underwent endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) between 2007 and 2010 at a single institution were retrospectively analyzed. Of the 161 cases, 19 patients who had coupling stent-grafting because of AAA proximal neck angulation greater than 60°, conical neck, or iliac tortuosity were included. Patient age ranged from 62 to 87 years (mean, 73.3 y). Mean follow-up was 18.7 months (range, 1-36 mo). The coupling stent-graft technique was defined by the use of suprarenal fixation device main bodies (Zenith or Talent) with one or more EXCLUDER limbs to adapt tortuous and angulated iliac arteries. Pretreatment contrast-enhanced CT was analyzed based on three-dimensional and multiplanar reformatted images. Follow-up contrast-enhanced CT was also analyzed. Results: Mean aneurysm diameter was 68.9 mm ± 14.0, neck length was 32.7 mm ± 15.1, and neck angulation was 68.9° ± 11.5. Conical neck shapes were present in four patients (21.1{\%}) and ruptured AAAs were present in two (10.5{\%}). Among 38 iliac arteries, the mean iliac artery tortuosity index was 1.52 ± 0.27 and iliac angle was 106.8° ± 18.1. Three patients (15.8{\%}) underwent repeat intervention: placement of a balloon-expandable stent in the proximal neck for type I endoleak (n = 1), endovascular embolization for proximal type I endoleak (n = 1), and percutaneous approach following endovascular embolization for type II endoleak (n = 1). No type III endoleak, limb occlusion, limb kinking, or stent-graft migration developed. Conclusions: The coupling stent-graft technique is technically feasible, with acceptable midterm outcomes in EVAR of AAA in patients with unfavorable neck and iliac anatomies.",
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Coupling bifurcated stent-grafts to overcome anatomic limitations of endovascular repair of abdominal aortic aneurysms. / Lee, Myungsu; Lee, Do Yun; Kim, ManDeuk; Lee, Kwang Hun; Lee, Mu Sook; Park, Sung Il; Won, Jong Yun; Choi, Donghoon; Ko, Young Guk.

In: Journal of Vascular and Interventional Radiology, Vol. 23, No. 8, 01.08.2012, p. 1065-1069.

Research output: Contribution to journalArticle

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T1 - Coupling bifurcated stent-grafts to overcome anatomic limitations of endovascular repair of abdominal aortic aneurysms

AU - Lee, Myungsu

AU - Lee, Do Yun

AU - Kim, ManDeuk

AU - Lee, Kwang Hun

AU - Lee, Mu Sook

AU - Park, Sung Il

AU - Won, Jong Yun

AU - Choi, Donghoon

AU - Ko, Young Guk

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N2 - Purpose: To evaluate the effectiveness of the coupling stent-graft technique and outcomes on contrast-enhanced computed tomography (CT). Materials and Methods: All patients who underwent endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) between 2007 and 2010 at a single institution were retrospectively analyzed. Of the 161 cases, 19 patients who had coupling stent-grafting because of AAA proximal neck angulation greater than 60°, conical neck, or iliac tortuosity were included. Patient age ranged from 62 to 87 years (mean, 73.3 y). Mean follow-up was 18.7 months (range, 1-36 mo). The coupling stent-graft technique was defined by the use of suprarenal fixation device main bodies (Zenith or Talent) with one or more EXCLUDER limbs to adapt tortuous and angulated iliac arteries. Pretreatment contrast-enhanced CT was analyzed based on three-dimensional and multiplanar reformatted images. Follow-up contrast-enhanced CT was also analyzed. Results: Mean aneurysm diameter was 68.9 mm ± 14.0, neck length was 32.7 mm ± 15.1, and neck angulation was 68.9° ± 11.5. Conical neck shapes were present in four patients (21.1%) and ruptured AAAs were present in two (10.5%). Among 38 iliac arteries, the mean iliac artery tortuosity index was 1.52 ± 0.27 and iliac angle was 106.8° ± 18.1. Three patients (15.8%) underwent repeat intervention: placement of a balloon-expandable stent in the proximal neck for type I endoleak (n = 1), endovascular embolization for proximal type I endoleak (n = 1), and percutaneous approach following endovascular embolization for type II endoleak (n = 1). No type III endoleak, limb occlusion, limb kinking, or stent-graft migration developed. Conclusions: The coupling stent-graft technique is technically feasible, with acceptable midterm outcomes in EVAR of AAA in patients with unfavorable neck and iliac anatomies.

AB - Purpose: To evaluate the effectiveness of the coupling stent-graft technique and outcomes on contrast-enhanced computed tomography (CT). Materials and Methods: All patients who underwent endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) between 2007 and 2010 at a single institution were retrospectively analyzed. Of the 161 cases, 19 patients who had coupling stent-grafting because of AAA proximal neck angulation greater than 60°, conical neck, or iliac tortuosity were included. Patient age ranged from 62 to 87 years (mean, 73.3 y). Mean follow-up was 18.7 months (range, 1-36 mo). The coupling stent-graft technique was defined by the use of suprarenal fixation device main bodies (Zenith or Talent) with one or more EXCLUDER limbs to adapt tortuous and angulated iliac arteries. Pretreatment contrast-enhanced CT was analyzed based on three-dimensional and multiplanar reformatted images. Follow-up contrast-enhanced CT was also analyzed. Results: Mean aneurysm diameter was 68.9 mm ± 14.0, neck length was 32.7 mm ± 15.1, and neck angulation was 68.9° ± 11.5. Conical neck shapes were present in four patients (21.1%) and ruptured AAAs were present in two (10.5%). Among 38 iliac arteries, the mean iliac artery tortuosity index was 1.52 ± 0.27 and iliac angle was 106.8° ± 18.1. Three patients (15.8%) underwent repeat intervention: placement of a balloon-expandable stent in the proximal neck for type I endoleak (n = 1), endovascular embolization for proximal type I endoleak (n = 1), and percutaneous approach following endovascular embolization for type II endoleak (n = 1). No type III endoleak, limb occlusion, limb kinking, or stent-graft migration developed. Conclusions: The coupling stent-graft technique is technically feasible, with acceptable midterm outcomes in EVAR of AAA in patients with unfavorable neck and iliac anatomies.

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