ENDOVASCULAR GRAFTING FOR ANEURYSM OF THE DISTAL AORTIC ARCH

Stent-graft Devices and Delivery Systems We evaluat ed stent-graft devices and delivery systems for endovascular grafting for aneurysms of the distal aortic arch.

Abstract

Stent-graft Devices and Delivery Systems We evaluat ed stent-graft devices and delivery systems for endovascular grafting for aneurysms of the distal aortic arch. The stent-grafts consisted of a self expandable Gianturco-Z stent and a woven polyester graft. They were delivered through a J-shaped 20Fr. or 24Fr. Teflon sheath. Under drug-induced hypotension or transient cardiac arrest, the proximal edge of the stent-graft was deployed in juxtaposition to the left common carotid artery in 8 cases, in juxtaposition to the left subclavian artery in 1 case, and in the descending aorta in 2 cases. The first stent-graft in most cases migrated 1-2.5 cm distal from the precise position. We made 2 stent-grafts with a proximal bare stent to prevent the migration. Endoleak did not develop in 2 cases with the descending aneurysm, but it diddevelop in 5 of 8 cases with a distal arch aneurysm, even after a second stent-graft deployment in 7 cases. Aneurysms of the distal aortic arch with a proximal neck diameter of less than 36 mm and a length greater than 20 mm did not suffer from endoleak. Endovascular grafting for the distal arch aneurysm requires devices such as a second stent-graft, a bare stent-graft, or over the guide wire delivery systems preventing distal migration of the stent-graft and endoleaking.