Abdominal aortic aneurysm repair using an aortoiliac stent-graft combined with femoral-femoral bypass

The purpose of this article is to describe the technique of endovascular repair of infrarenal abdominal aortic aneurysms (AAA) combined with surgical bypass. Eleven patients (eight men, three women; mean age, 64.6 years) underwent stent-graft repair of AAA using a nonbifurcated Z-stent covered with polyester or polytetrafluoroethylene (PTFE) fabric delivered through a 14F to 20F delivery catheter under fluoroscopic control. The stent-graft was used to bridge the infrarenal aorta and common iliac artery. After embolization of the contralateral common iliac artery using a self-expanding vascular occluder (SEVO), a femoral-femoral bypass was surgically created using a reinforced PTFE graft. Immediate and complete thrombosis of the aneurysm occurred in 7 of 11 patients (74%) after stent-graft, SEVO placement, and surgical bypass. Four patients required secondary interventions to repair endoleaks at the proximal anastomosis (n = 2) or leaks at the site of SEVO deployment (n = 3). One patient required only a nontapered aortic stent-graft and did not require a femoral-femoral bypass. After all endovascular procedures, no patients had back-bleeding into the aneurysm, device migration, microembolization, limb ischemia, or neurological sequelae (mean follow-up, 140 days; range, 50 to 200). All 11 patients had complete thrombosis of the aneurysm at follow-up. A nonbifurcated stent-graft can be used successfully in treating infrarenal AAAs in combination with a surgical femoral-femoral bypass.