Journal «Angiology and Vascular Surgery» • 

1999 • VOLUME 5 • №1

STENT-GRAFT: NEW TECHNIQUE FOR TREATMENT OF ANEURYSMS, TRAUMATIC AND OCCLUSIVE ARTERIAL LESIONS

Parodi J.C., Schonholz C.J.
Department of Vascular Surgery, Instituto Cardiovascular de Buenos Aires, Department of Interventional Radiology, Clinica La Sagrada Familia,
Buenos Aires, Argentina

The diagnosis of AAA has been established with increasing frequency during the past two decades. This observation probably is related to aging of the populations, as well as to the extensive use of ultrasonography and computerized tomographic scanning for different pathologies. Although AAA may occasionally cause distal embolization, rupture remains the most common and deadly complication. Elective replacement with a synthetic graft has proved to be the most appropriate method to prevent AAA rupture for nearly forty years, and at respected medical centers, it has been associated with a postoperative mortality of less than 5%. Increasingly, vascular surgeons are encountering older patients with severe co-morbid conditions. This can increase operative morbidity and may even elevate mortality of aortic surgery to a figure in excess of 60%. It seems inevitable, that every vascular surgeon will, with some frequency, encounter patients who represent a prohibitive risk for conventional graft replacement. Other alternative form of treatment (such as axillofemoral bypass in conjunction with induced AAA thrombosis) have been abandoned despite preliminary reports of their initial success. In 1976, we began to develop a plan for endovascular treatment of AAA which was based upon the fundamental principles of aortic replacement. We developed two prototypes being the first a self expandable metal cage with a zig-zag configuration covered by a nylon fabric and the second a silastic bag with a cylindrical lumen. We eventually abandoned both of these prototypes because the discouraging results we had in animal experiences. With the stent technology emerging in the field of endovascular treatment, we reinitiated our project in 1988 using balloon expandable stents. Our current approach is predicated upon the concept that stents may be used in place of sutures to secure the proximal and distal ends of a fabric graft extending the length of the AAA, thoracic aneurysm or recanalized occluded artery. In arteriovenous fistulas and false aneurysms, a covered balloon or self expandable stent has been used. A tubular dacron or polytetrafluoroethylene (PTFE) graft, urethane fibers or a segment of autologous deep vein has been used to cover stents.

P. 72-88

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