Abdominal Aortic Aneurysm Repair Using the Meadox/Vanguard Prosthesis: Indications, Implantation Technique, and Results

The purpose of developing percutaneously placed endoluminal stent-grafts for the treatment of aortic aneurysms is to avoid major intra-abdominal surgery and related morbidity and mortality. To define its clinical utility, the authors prospectively studied polyester-covered nitinol stents for the treatment of infrarenal abdominal aortic aneurysms (AAAs). Since 1994, the authors implanted in a total of 228 patients nonbifurcated or bifurcated stent-grafts based on a self-expandable nitinol framework covered with a thin polyester fabric for the endovascular repair of infrarenal AAA. The patient cohort was divided into two subgroups: Group 1 (n = 120) consisted of patients treated with use of the original stent-graft; Group 2 (n = 108) comprised patients treated with the refined stent-graft. Preprocedural evaluation with precise determination of the length and diameter of the proximal neck and the common iliac arteries was based on spiral computed tomography, intra-arterial angiography, and magnetic resonance angiography. The initial technical success rates in patients of Group 1 presenting with a type A aneurysm (n = 9), and type B or C aneurysms (n = 111) were 78% and 82%, respectively. Minor and major complications, including one 30-day mortality, were observed in 14 patients (11.7%). With refinement of the polyester cover as a consequence from our initial experiences, we achieved in Group 2 for type A (n = 8), and type B or C aneurysms (n = 100) primary success rates of 100% and 97%, respectively. The rate of local and remote complications in this group was 6.5%. Based on our initial and mid-term results, endoluminal repair of infrarenal AAA with use of straight or bifurcated stent-grafts is a feasible alternative to conventional surgical repair associated with a low rate of morbidity and mortality.