[Tailored endoprostheses for the endovascular treatment of aorto-iliac aneurysms: current features and perspectives]

Abstract

We describe here our preliminary experience with the almost exclusive use of a range of made to measure stent-grafts home-made from commercially available components. From January 1996 to December 1999, 188 aortoiliac aneurysms (AIA) were treated with stent-grafts that were home-made to measure using Z autoexpandable stainless steel stents connected with polyester sutures and covered with commercially available polyester vascular prostheses. These stent-grafts were implanted through 18 to 24 (typically 20) Fr. commercially available introducers via a surgical remote access. Made to measure tubular, bifurcated, tapered, and/or blind stents combined with extra-anatomic bypass designs increased the rate of endovascular treatment (ET) of AIA in this series. This rate was further increased through the use of uncovered proximal or distal stents when dealing with short or tortuous necks near major side branches and through use of hybrid, partly surgical designs, one with stented and the other with stentless ends, the latter allowing for a surgically made anastomosis. The results of our experience with these techniques show that use of home-made to measure stent-grafts greatly increases the feasibility of the ET of AIA among unselected patients while offering enough efficiency and safety to deserve further investigation. Future perspectives are discussed.