Elsevier

Cardiovascular Surgery

Volume 6, Issue 3, June 1998, Pages 220-225
Cardiovascular Surgery

VASCULAR REVIEWS
The Perth HLB bifurcated endoluminal graft: A review of the experience and intermediate results

https://doi.org/10.1016/S0967-2109(97)00140-3Get rights and content

Abstract

Endoluminal grafting for abdominal aortic aneurysm based upon Dacron-coated Z stents was commenced in March 1993. A modular system for treatment of infrarenal aorto-iliac aneurysmal disease was developed in 1994. The experimental model, method of delivery, graft construction and initial results were reported. Since 1994, 108 bifurcated HLB (Perth) endografts for infrarenal aorto-iliac aneurysmal disease have been implemented. Initial technical success in deployment and exclusion of the aneurysm was achieved in 94 (87%) cases. Secondary endovascular procedures were performed in six cases and were successful in excluding the aneurysm. Ninety patients are alive currently. Twelve have died of co-morbid conditions. Six have died of aneurysmal disease, either from rupture or the result of treatment attempts. Fifteen early endoleaks (within 30 days) have been detected with three persisting. Four have sealed without further intervention, six after the secondary procedure and two patients have died. Conversion to open aneurysmal repair has been performed in five cases: three early and two late. Two of the early group but none of the late intervention group died. No graft infections have been detected to date. With increasing experience criteria for patient selection for endoluminal grafting and the type of graft to be inserted, have been developed. These criteria, lessons learnt and technical points of importance are discussed.

Section snippets

Material and methods

Patients with aneurysmal disease of the infrarenal aorta and iliac arteries with a high risk of open surgery were considered for endoluminal graft. Patients were considered high risk if their age was greater than 80 years or there was history of cardiac disease, respiratory disease, end stage chronic renal failure, hostile abdomen, haematological abnormalities or previous cerebrovascular accident. After fulfilling the criteria for endoluminal grafting, patients were assessed for anatomical

Results

Since 1993, a total of 136 endoluminal grafts have been placed for aneurysmal disease of which 108 have been bifurcated grafts for infrarenal aorto-iliac aneurysmal disease. All the grafts were made in one institution and had similar components.

For the bifurcated system, the operating time and blood loss reduced with experience and improvement in technique and devices used (Table 1): initial technical success in deployment and exclusion of the aneurysm was achieved in 94 cases. Secondary

Discussion

The technical success rates, early and late complications and endoleaks are similar to other reports in the literature 4, 5, 6. Lessons learnt from our experience are discussed below and reinforce the reports from other centres that perform endoluminal grafting 4, 5, 6, 7, 8.

Future predictions

The ultimate aim of endoluminal grafting is to treat any aneurysm at any site by a percutaneous technique. To accomplish the first of these objectives, fenestrated grafts or grafts with extension pieces to visceral vessels will allow treatment of aneurysms involving the visceral arteries: to insert a complete endograft percutaneously if the delivery system and the graft need to be reduced in size, while maintaining their strength and durability. Newer materials for both components will be

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