Portal de Periódicos da CAPES

Is cross-femoral bypass grafting a disadvantage of aortomonoiliac endovascular aortic aneurysm repair?

2003; Elsevier BV; Volume: 38; Issue: 4 Linguagem: Inglês

10.1016/s0741-5214(03)00721-3

1097-6809

Lâl P.K Yilmaz, Cherrie Z. Abraham, Linda M. Reilly, Roy L. Gordon, Darren B. Schneider, Louis M. Messina, Timothy A.M. Chuter,

Peripheral Artery Disease Management

The need for cross-femoral bypass grafting (CFBG) is considered by some to be a major disadvantage of endovascular aneurysm repair (EVAR) with the aortomonoiliac technique. To determine the durability of CFBG in this setting, we examined data from 148 consecutive high-risk patients in a clinical trial of EVAR with a custom-made aortomonoiliac endovascular stent graft.All data were collected prospectively. After hospital discharge, patients were evaluated at 1, 3, and 6 months and annually thereafter. All CFBG was constructed of expandable polytetrafluoroethylene.During follow-up averaging 23.6 +/- 16.2 months, nine CFBG complications developed in 8 patients (5.4%), including disruption (n = 2), infection (n = 3), thrombosis (n = 2), and pseudoaneurysm (n = 3). Four patients with CFBG complications died, of consequences of infection (n = 2), intracranial hemorrhage during attempted CFBG thrombolysis (n = 1), and intracranial hemorrhage during anticoagulation (n = 1). There were no amputations. At life table analysis, freedom from CFBG complication was 96.3% +/- 1.6% at 12 months, 94.1% +/- 2.2% at 24, 36, and 48 months, and 86.2% +/- 7.8% at 60 months. Overall survival for this high-risk patient group was 83.4% +/- 3.1% at 12 months, 70.4% +/- 4.1% at 24 months, 56.5% +/- 5.3% at 36 months, and 44.8% +/- 6.4% at 48 months.CFBG is durable, with a low rate of complications in patients undergoing aortomonoiliac EVAR. Need for CFBG should not discourage use of aortomonoiliac devices in patients with anatomy unfavorable for other EVAR approaches.