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Park, Kim, Byun, Kang, Choi, and Park: Endovascular Therapy for Abdominal Aortic Aneurysm and Iliac Artery Aneurysm Using SEAL Aortic Stent-Graft: A Single Center Experience
Interventional Radiology

Journal of the Korean Society of Radiology 2015; 72(3): 156-163.

Published online: 6 March 2015

DOI: https://doi.org/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

Su Young Park, MD1, Jeong Ho Kim, MD1, Sung Su Byun, MD1, Jin Mo Kang, MD2, Sang Tae Choi, MD2, Jae Hyung Park, MD1

1Department of Radiology, Gachon University Gil Hospital, Incheon, Korea.

2Department of Vascular Surgery, Gachon University Gil Hospital, Incheon, Korea.

Corresponding author: Jeong Ho Kim, MD. Department of Radiology, Gachon University Gil Hospital, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 405-760, Korea. Tel. 82-32-460-3065, Fax. 82-32-460-3063, ho7ok7@gilhospital.com

Received 21 September 2014       Accepted 29 October 2014

Copyright © 2015 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Aortic Stent-Graft, Abdominal Aorta, Iliac Artery, Aneurysm, Endovascular Aneurysm Repair

Figures and Tables

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.
jksr-72-156-g002
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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Table 1

Summary of 33 Patients with Aortoiliac Aneurysms Treated with SEAL Aortic Stent-Graft Placement

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Pts Sex/Age Initial Diagnosis* Proximal Neck CIA EIA SG Type‡ TS§ Endoleak∥ Other Cx CS** Cause of Death Figures
Diameter Length Angle Wall† Diameter Length Diameter Type Detection Time Additional Intervention Outcome
1 M/72 AAA 28 25 35 T 18 40 8 B O Steno O Aspiration
2 M/79 AAA with R 26 30 5 T 16 28 8 B O Steno O Sepsis
3 M/68 IAA 28 105 24 55 11 B O O
4 M/62 IAA 28 180 19 140 12 B O O
5 M/64 AAA 24 35 18 T 12 56 6 B O O
6 M/56 AAA 20 35 15 13 68 7 B O O Gastric cancer
7 F/74 AAA 34 0 25 12 39 7 B O 3 N (48 mo) Additional stent-graft On F/U Migr O Fig. 2
8 M/69 AAA + IAA 26 35 60 46 77 8 B O O
9 M/78 AAA 19 21 51 16 27 8 B O O
10 M/66 AAA 32 16 11 18 32 7 B O 1B N (59 mo) Additional stent-graft F/U loss Migr X Delayed AAA rupture
11 M/65 AAA 27 40 18 C 15 25 9 B O 2 (IMA) R IMA embolization Disapp Steno O
12 M/75 AAA 22 50 35 C 16 25 10 B O 1B R ↓ O
13 M/69 AAA + IAA 20 50 13 52 45 12 B O O
14 M/83 AAA with CR 32 33 116 T 19 33 11 B X X AAA rupture
15 F/76 AAA 32 30 39 24 24 8 B O O
16 F/88 AAA 23 79 89 17 33 8 B O 1A R F/U loss X
17 M/81 AAA 31 30 57 C 21 35 9 B O 1B R F/U loss X
18 M/67 AAA with R 26 45 32 14 25 7 B O 1B N (41 mo) Additional stent-graft On F/U Migr O
19 M/64 AAA 26 55 44 T 13 40 7 B O O
20 M/70 AAA + IAA 20 75 46 39 40 10 B O 2 (L) R ↓ Steno O
21 F/77 AAA with R 20 27 91 12 18 9 B O O
22 F/75 AAA with CR 23 45 41 T 14 20 7 B O O
23 M/58 AAA with CR 23 36 33 16 37 10 B O O
24 M/82 AAA 22 27 68 T 17 39 11 B O 2 (IMA) R F/U loss X Acute MI Fig. 3
25 F/85 AAA with R 17 30 30 C 9 20 6 B O X AAA rupture
26 M/71 AAA 21 75 30 12 20 11 B O 2 (IMA) R ↓ O
27 M/74 AAA 33 59 93 T 24 36 11 B O 2 (L) R Disapp X
5 N (28 mo) On F/U
28 M/80 AAA 26 35 89 25 25 11 B O 2 (L) R ↓ O
29 M/80 AAA 25 24 78 15 39 9 B O O
30 M/66 AAA 22 21 74 12 21 10 B O O
31 M/84 AAA 28 35 62 20 20 9 B O O Medullary paralysis
32 M/76 IAA with R 29 120 C 36 55 12 B O 2 (IIA) R ↓ O
33 M/79 AAA 25 30 38 20 30 8 B O O

Note.-*Initial diagnosis: AAA = abdominal aortic aneurysm, IAA = iliac artery aneurysm, R = rupture, CR = contained rupture

†Proximal neck wall: T = thrombosis, C = calcification

‡Stent-graft types: B = bifurcated type, T = tubular type

§Technical success: O = success, X = failed

∥Endoleak type: IMA = inferior mesenteric artery, L = lumbar artery, Endoleak detection time = interval between initial intervention and initially detected time (months), N = newly appeared endoleak, R = residual endoleak, Outcome: F/U = follow-up, Disapp = disappeared endoleak on follow-up CT, ↓ = decreased endoleak on follow-up CT

Other complications: Steno = limb stent-graft stenosis, Migr = stent-graft migration

**Clinical success: O = success, X = failed

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