Purpose: To report the use of endovascular grafting to repair degenerative aneurysmal changes in an extra-anatomic bypass graft.
Methods: A 14-year-old extra-anatomic ascending aorta-to-left common femoral bypass graft ("ventral aorta") had undergone aneurysmal degeneration, producing symptoms of progressive claudication and local abdominal swelling. The aneurysmal graft dilatation began within the thoracic cavity and extended through the entire extraperitoneal abdominal segment. The option for minimally invasive repair using a customized stent-graft device was offered to the patient as an alternative to standard reoperation.
Results: An 8-mm x 42-cm endovascular graft was constructed by polytetrafluoroethylene with 30-mm Palmaz stents sutured to each end. With balloon occlusion of antegrade and retrograde blood flow, the stent-graft was delivered retrograde through an incision in the distal end of the existing bypass graft. The device was successfully positioned and deployed with complete exclusion of the aneurysm. No complications occurred, and the patient's symptoms abated. Follow-up arteriography at 1 months showed a pseudoaneurysm at the distal graft incision site; surgical repair was necessary. At 6 months, angiography demonstrated continued patency of the extra-anatomic bypass graft.
Conclusions: Intraluminal aneurysm exclusion techniques in degenerated extra-anatomic bypass grafts may evolve into a viable therapeutic alternative to complex reoperative surgery.