J Korean Soc Radiol.  2015 Mar;72(3):156-163. 10.3348/jksr.2015.72.3.156.

Endovascular Therapy for Abdominal Aortic Aneurysm and Iliac Artery Aneurysm Using SEAL Aortic Stent-Graft: A Single Center Experience

• Park SY
• Kim JH
• Byun SS
• Kang JM
• Choi ST
• Park JH

• KMID: 2161166
• DOI: http://doi.org/10.3348/jksr.2015.72.3.156

Abstract

PURPOSE
The aim of this study was to evaluate the safety and efficacy of SEAL aortic stent-graft for abdominal aortoiliac aneurysms.
MATERIALS AND METHODS
Between October 2007 and January 2014, 33 patients with abdominal aortoiliac aneurysms were treated with SEAL aortic stent-graft. We evaluated the technical success rate, clinical and CT follow-up periods, major complications, need for additional interventional treatment, aneurysm-related mortality and clinical success rate.
RESULTS
SEAL bifurcated aortic stent-graft was successfully placed in 32 patients (97%). Clinical and CT follow-up periods were 24 and 14 months, respectively. Endoleak developed in 13 patients (41%): spontaneous regression or decrease in 6, need for additional treatment in 4 and follow-up loss in 3. Significant stenosis of stent-graft occurred in 4 patients (12%) and was treated with stenting in 3. Migration of stent-graft was noted in 3 patients (9%) and treated with additional stent-grafting. Aneurysm-related mortality was 9% (3 of 33). The placement of SEAL stent-graft was effective in 26 patients (79%).
CONCLUSION
The placement of SEAL aortic stent-graft was safe and effective in patients with aneurysms of abdominal aorta and iliac arteries. However, complicating endoleaks, stenosis and migration of the stent-graft developed during the follow-up. Therefore, regular CT follow-up seems to be mandatory.

MeSH Terms

Aneurysm*
Aorta, Abdominal
Aortic Aneurysm, Abdominal*
Constriction, Pathologic
Endoleak
Follow-Up Studies
Humans
Iliac Artery*
Mortality
Stents

Figure

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  Fig. 1 Flowchart showing follow-up results of endoleaks.

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  Fig. 2 A 74-year-old female with abdominal aortic aneurysm (patient number 7 on Table 1). A. Preimplantation abdominal aortogram demonstrated "hostile" proximal neck (arrow) which has flask shaped appearance. B. Postimplantation abdominal aortogram showed good placement of aortic stent-graft without evidence of endoleak. C. Volume-rendering CT image showed no endoleak on 5 days of the placement of aortic stent-graft. D. Maximum intensity projection CT image revealed newly developed type 3 endoleak (arrow) between main body and right limb stent-graft on 48 months after the placement of aortic stent-graft.

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  Fig. 3 An 82-year-old male with abdominal aortic aneurysm with bilateral common iliac artery involvement (patient number 24 on Table 1). A. Preimplantation abdominal aortogram showed diffuse dilatation of infrarenal abdominal aorta and bilateral common iliac arteries. The proximal neck had "hostile" anatomy due to severe angulation. B. Postimplantation abdominal aortogram showed good placement of aortic stent-graft without evidence of endoleak. However, left proximal limb stent-graft (arrow) showed significant stenosis due to angulation. C, D. On 19 days after aortic stent-graft placement, we performed balloon angioplasty (C) and placement of balloon-expandable stent (D) at left proximal limb stent-graft. There was a waist (arrow) during balloon angioplasty showing significant stenosis.

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