ABSTRACT
Currently, two varieties of endovascular devices are being used clinically to treat symptomatic aortoiliac lesions. The first type is inserted percutaneously, usually in an interventional suite, and consists of a short self-expanding stent that is covered along its entire length by prosthetic material. These types of devices, also known as covered stents, are similar to conventional stents and have been used to treat short segmental lesions that have undergone balloon angioplasty. At Montefiore Medical Center in New York, our focus has been on using a device which is conceptually more similar to a surgically inserted bypass graft than a conventional stent. We perform our procedure in the operating suite and obtain open exposure of a relevant
access vessel-usually the common femoral artery. Fluoroscopic guidance is used to insert a device consisting of a long prosthetic graft attached to a Palmaz balloonexpandable stent (Johnson & Johnson Interventional Systems, Warren, NJ, USA). The stent portion of the device fixes the graft to the luminal surface of the artery proximal to the site of disease. The distal aspect of the graft is retrieved from within the arteriotomy and the distal anastomosis is hand sewn according to the patient s pattern of outflow disease. In contrast to covered stents, these endovascular grafts reline the entire length of the diseased vasculature. Therefore, they can be used to treat patients with long segment aortoiliac disease. In addition, because the distal anastomosis can be tailored to the patients’ pattern of infrainguinal occlusive disease as well, a wider range of potential patients can be treated.
