Transfemoral Intraluminal Graft Implantation for Abdominal Aortic Aneurysms

      This paper is only available as a PDF. To read, Please Download here.
      This study reports on animal experimentation and initial clinical trials exploring the feasibility of exclusion of an abdominal aortic aneurysm by placement of an intraluminal, stent-anchored, Dacron prosthetic graft using retrograde cannulation of the common femoral artery under local or regional anesthesia. Experiments showed that when a balloon-expandable stent was sutured to the partially overlapping ends of a tubular, knitted Dacron graft, friction seals were created which fixed the ends of the graft to the vessel wall. This excludes the aneurysm from circulation and allows normal flow through the graft lumen. Initial treatment in five patients with serious co-morbidities is described. Each patient had an individually tailored balloon diameter and diameter and length of their Dacron graft. Standard stents were used and the diameter of the stent-graft was determined by sonography, computed tomography, and arteriography. In three of them a cephalic stent was used without a distal stent. In two other patients both ends of the Dacron tubular stent were attached to stents using a one-third stent overlap. In these latter two, once the proximal neck of the aneurysm was reached, the sheath was withdrawn and the cephalic balloon inflated with a saline/contrast solution. The catheter was gently removed caudally towards the arterial entry site In the groin to keep tension on the graft, and the second balloon inflated so as to deploy the second stent. Four of the five patients had heparin reversal at the end of the procedure. We are encouraged by this early experience, but believe that further developments and more clinical trials are needed before this technique becomes widely used.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Annals of Vascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Blakemore A
        Progressive, constrictive occlusion of the abdominal aorta with wiring and electrothermic coagulation: one-stage operation for arteriosclerotic aneurysm of the abdominal aortic.
        Ann Surg. 1951; 133: 447-462
        • Robicsek F
        • Daugherty HK
        • Mullen DC
        External grafting of aortic aneurysms.
        J Thorac Cardiovasc Surg. 1971; 61: 131-134
        • Berguer R
        • Schneider J
        • Wilner HI
        Induced thrombosis in inoperable abdominal aortic aneurysm.
        Surgery. 1978; 64: 425-429
        • Hollier LH
        Surgical management of abdominal aortic aneurysm in the high-risk patient.
        Surg Clin N Am. 1986; 66: 269-279
        • Karmody AM
        • Leather RP
        • Goldman MP
        • et al.
        The current position of non-resection treatment for abdominal aortic aneurysms.
        Surgery. 1983; 94: 591-597
        • Kwaan JHM
        • Dahl RK
        Fatal rupture after successful surgical thrombosis of an abdominal aortic aneurysm.
        Surgery. 1984; 95: 235-237
        • Schanzer H
        • Papa MC
        • Miller CM
        Rupture of surgically thrombosed abdominal aortic aneurysm.
        J Vasc Surg. 1985; 2: 278-280
        • Mc Farland MJ
        The epidemiologic necroscopy for abdominal aortic aneurysm.
        JAMA. 1991; 265: 2085-2088
        • Turk K
        Postmortem incidence of abdominal aortic aneurysms.
        Proc R Soc Med. 1965; 58: 869-870
        • Carlsson J
        • Sternby N
        Acta Chir Scand. 1964; 127: 466-473
        • Melton NJ
        • Bickerstaff LK
        • Hollier LH
        • et al.
        Changing incidence of abdominal aortic aneurysms: a population-based study.
        Am J Epidemiol. 1984; 120: 379-386
        • Webster MW
        • St Jean PL
        • Steed DL
        • et al.
        Abdominal aortic aneurysm: results of a family study.
        J Vasc Surg. 1991; 13: 366-372
        • O'Kelly TJ
        • Heather BP
        General practice based population screening for abdominal aortic aneurysm in a pilot study.
        Br J Surg. 1989; 76: 479-480
        • Collin J
        • Leandro A
        • Walton J
        • et al.
        Oxford screening programme for abdominal aortic aneurysm in men aged 65 to 74 years.
        Lancet. 1988; 2: 613-615
        • Dubost C
        • Allary M
        • Oeconomos N
        Resection of an aneurysm of the abdominal aortic, reestablishment of continuity by preserved human arterial graft with results after 5 months.
        Arch Surg. 1952; 64: 405
        • Brown OW
        • Hollier LH
        • Pairolero PC
        • et al.
        Abdominal aortic aneurysm and coronary artery disease: a reassessment.
        Arch Surg. 1981; 116: 148
        • Johansson G
        • Nydahl S
        • Olofsson P
        • et al.
        Survival in patients with abdominal aortic aneurysms: comparison between operative and nonoperative management.
        Eur J Vasc Surg. 1990; 4: 497-502
        • Mccombs RP
        • Roberts B
        Acute renal failure after resection of abdominal aortic aneurysm.
        Surg Gynecol Obstet. 1979; 148: 175-179
      1. Parodi JC, Palmaz JC, Barone HD, et al. Tratamiento endoluminal de los aneurismas de aorta abdominal: estudio experimental. Presented at II Convencion de Cirujanos Vasculares de Habla Hispana. October 13, 1990. Buenos Aires, Argentina. Summary, Page 122. Editor J.M. Capdevila, Barcelona, Spain.

      2. Palmaz JC, Parodi JC, Barone HD, et al. Transluminal bypass of experimental abdominal aortic aneurysm. Presented at 76th Scientific Assembly and Annual Meeting of RSNA. November 25–30, 1990. Summary.

      3. Parodi JC, Palmaz JC, Barone HD, et al. Transluminal aneurysm bypass: experimental observations and preliminary clinical experiences. Presented at International Congress IV. Endovascular Therapies in Vascular Disease. Scottsdale, Arizona. February 1991, Summary.

        • Szilagyi DE
        • Smith RF
        • Deruso FI
        • et al.
        Contribution of abdominal aortic aneurysmectomy to prolongation of life.
        Ann Surg. 1966; 164: 676-699
        • Darling RC
        • Brewster DC
        Elective treatment of abdominal aortic aneurysm.
        World J Surg. 1980; 4: 661-667
        • Cronenwett JL
        • Murphy TF
        • Zelenock GN
        • et al.
        Actuarial analysis of variables associated with rupture of small abdominal aortic aneurysms.
        Surgery. 1985; 98: 472-483
        • Palmaz JC
        • Richter GM
        • Noeldge G
        • et al.
        Intraluminal stents in atherosclerotic iliac artery stenosis: preliminary report of multicenter study.
        Radiology. 1988; 168: 727-731
        • Rees CR
        • Palmaz JC
        • Garcia O
        • et al.
        Angioplasty and stenting of completely occluded iliac arteries.
        Radiology. 1989; 172: 953-959