The inability to obtain or maintain a secure seal between a vessel wall and a transluminally implanted intra-aneurysmal graft is a complication unique to the evolving technique of endovascular aneurysm exclusion. Because the term “leak” has long been associated with aneurysm rupture, the term “endoleak” is proposed as a more definitive description of this phenomenon.Embracing both persistent blood flow into the aneurysmal sac from within or around the graft (graft related) and from patent collateral arteries (nongraft related), endoleak can be classified as primary or secondary depending on the time of occurrence (within 30 days of implantation or following apparent initial seal, respectively).Diagnostic techniques to detect endoleak include arteriography, intraprocedural pressure monitoring, contrast-enhanced computed tomography, abdominal X ray, and duplex scanning. Management strategies for endoleak range from observation with periodic imaging surveillance to correction by additional endoluminal or sur...

Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management.

https://www.jvascsurg.org/article/S0741-5214(02)05407-1/pdf

Nature and significance of endoleaks and endotension: Summary of opinions expressed at an international conference

Early complications and endoleaks after endovascular abdominal aortic aneurysm repair: Report of a multicenter study

A method and apparatus for performing coronary artery bypass surgery establishes a channel leading directly from a chamber of a heart into a coronary artery with said channel retained open during both diastole and systole. The coronary artery bypass procedure may be performed with or without cardiopulmonary bypass.

Method and apparatus for performing coronary artery bypass surgery

Devices and methods for delivering conduits into the wall of a patient's heart to communicate a coronary vessel with a heart chamber. The devices are passed through the coronary vessel and the heart wall to place the conduit and establish a blood flow path between the vessel and the heart chamber. Additional devices and methods are provided for removing tissue from a coronary vessel or the heart wall to establish a flow path between the coronary vessel in communication with the heart chamber.

Delivering a conduit into a heart wall to place a coronary vessel in communication with a heart chamber and removing tissue from the vessel or heart wall to facilitate such communication

Objectives Complex arterial occlusive, traumatic, and aneurysmal lesions may be difficult or impossible to treat successfully by standard surgical techniques when severe medical or surgical comorbidities exist. The authors describe a single center's experience over a 2 1/2-year period with 96 endovascular graft procedures performed to treat 100 arterial lesions in 92 patients. Patients and Methods Thirty-three patients had 36 large aortic and/or peripheral artery aneurysms, 48 had 53 multilevel limb-threatening aortoiliac and/or femoropopliteal occlusive lesions, and 11 had traumatic arterial injuries (false aneurysms and arteriovenous fistulas). Endovascular grafts were placed through remote arteriotomies under local (16 [17%]), epidural (42 [43%]), or general (38 [40%]) anesthesia. Results Technical and clinical successes were achieved in 91% of the patients with aneurysms, 91% with occlusive lesions, and 100% with traumatic arterial lesions. These patients and grafts have been followed from 1 to 30 months (mean, 13 months). The primary and secondary patency rates at 18 months for aortoiliac occlusions were 77% and 95%, respectively. The 18-month limb salvage rate was 98%. Immediately after aortic aneurysm exclusion, a total of 6 (33%) perigraft channels were detected ; 3 of these closed within 8 weeks. Endovascular stented graft procedures were associated with a 10% major and a 14% minor complication rate. The overall 30-day mortality rate for this entire series was 6%. Conclusions This initial experience with endovascular graft repair of complex arterial lesions justifies further use and careful evaluation of this technique for major arterial reconstruction.

Initial experience with transluminally placed endovascular grafts for the treatment of complex vascular lesions.

Endovascular approaches for traumatic arterial lesions.

Varying strategies and devices for endovascular repair of abdominal aortic aneurysms.

Over the past 20 years, there have been significant advances in the treatment of aortoiliac occlusive disease (AIOD). Patients who formerly required endarterectomy or aortofemoral or extraanatomic bypasses may now be candidates for less invasive procedures such as balloon angioplasty and intraarterial stenting. 1 However, the indications for these procedures remain limited, and many patients, especially those with limb-threatening ischemia, still require open surgical repair. Although endovascular grafts are most often reported for the repair of aortic aneurysms and traumatic lesions, 2–5 they are also being used increasingly to treat aortoiliac disease. 6–11 By combining the durability of prosthetic grafts, a less invasive approach, and more widespread applicability than balloon angioplasty and stenting, endovascular grafting may have significant advantages over existing methods for treating advanced AIOD. These advantages may be most profound in patients in whom standard surgical or interventional procedures are difficult or impossible. To define the role of this new procedure, we reviewed our midterm experience using endovascular grafts to treat aortoiliac lesions in patients with limb-threatening ischemia.

Analysis of Endovascular Graft Treatment for Aortoiliac Occlusive Disease: What Is Its Role Based on Midterm Results?

The purpose of the study was to assess the usefulness of CT angiography for follow-up of patients with iliac artery aneurysms who have undergone endovascular treatment.Twelve patients with iliac artery aneurysms (10 true aneurysms and two pseudoaneurysms) were examined with CT angiography within 1 week of receiving transfemorally placed endovascular grafts. All patients underwent follow-up CT angiography from 3 to 30 months (mean, 11 months) later. Follow-up CT angiography at 6 months or later (mean, 14 months) was also available in 10 patients. All studies were obtained after i.v. contrast administration using 3-mm collimation, 1.6-2.0 pitch, 2-mm retrospective reconstruction, and with subsequent three-dimensional rendering and multiplanar reformation. The shape and patency of the graft, perigraft thrombosis, and the size of the aneurysm were assessed.All grafts remained patent and without deformity. Complete thrombosis of the aneurysm was shown by initial postoperative CT angiography in 11 patients and ...

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Luis A. Sanchez

Papers

Initial experience with transluminally placed endovascular grafts for the treatment of complex vascular lesions.

Endovascular approaches for traumatic arterial lesions.

Varying strategies and devices for endovascular repair of abdominal aortic aneurysms.

Analysis of Endovascular Graft Treatment for Aortoiliac Occlusive Disease: What Is Its Role Based on Midterm Results?

Value of CT angiography for postoperative assessment of patients with iliac artery aneurysms who have received endovascular grafts.