Early Outcomes of Aorto-Uniiliac Stent Graft with Femorofemoral Bypass for Abdominal Aortic Aneurysm
Khamin Chinsakchai MD*, Tossapol Prapassaro MD*, Pramook Mutirangura MD*, Chanean Ruansetakit MD*, Chumpol Wongwanit MD*, Nuttawut Sermsathanasawadi MD*, Suteekhanit Hahtapornsawan MD*, Supaporn Tunpornpituk MSc*, Kiattisak Hongku MD*
Affiliation : * Division of Vascular Surgery, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Endovascular repair for abdominal aortic aneurysm (AAA) was developed to provide a less invasive method
than the standard open procedure and has been reported to reduce perioperative mortality, hospital stays, and intensive care
unit (ICU) stays. However, an unfavorable anatomy precludes the use of a standard bifurcated stent graft, especially in cases
with narrow aortic bifurcation. The aorto-uni-iliac (AUI) configuration with a femorofemoral bypass graft appears to be a
good alternative in these patients.
Objective : To present the results of the AUI stent graft with femorofemoral bypass graft for AAA during perioperative
periods.
Material and Method: The data from 362 patients with AAA from January 2010 to December 2013 at a single institution were
retrospectively analyzed. Patients undergoing open repair or endovascular repair with bifurcated graft were excluded. Sixty-
two patients underwent AUI with femorofemoral bypass graft for treatment of AAA over the four-year period. Primary
endpoint was perioperative mortality. Secondary endpoints included procedural details, intra-operative adverse events,
postoperative complication, hospital stays, and perioperative re-intervention.
Results : Mean age was 75+8 years (range, 49 to 92 years). Thirty-two patients (61.3%) underwent AUI with femorofemoral
bypass graft for non-ruptured AAA and twenty-four patients (38.7%) were performed in ruptured AAA. The perioperative
mortality rate was 5.1%, all of which were ruptured AAA. Mean procedural blood loss was 514 mL (range 50 to 7,000 mL),
and 51.61% required intraoperative blood transfusion. Mean length of postoperative stays was 16.3 days (range, 2 to 59
days). There were eleven (18.6%), seventeen (28.8%) and twenty-four (37.3%) developed local, organ and infective
complications, respectively. In addition, seven patients (11.9%) needed perioperative re-intervention.
Conclusion : AUI stent graft and femorofemoral bypass graft for AAA is feasible in both elective and emergency situations
with a low perioperative mortality rate. This procedure is associated with an acceptable rate of perioperative complications
and early re-intervention.
Keywords : Abdominal aortic aneurysm, Aorto-uniiliac stent graft, Endovascular aneurysm repair
