Original Articles Korean Circulation J 1999;29 9 : Bifurcated Stent-Graft Vanguard 를이용한 복부대동맥류의경관적치료 심원흠 1 최동훈 1 윤영섭 1 이도연 2 장병철 3 Bifurcated S

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1 Original Articles Korean Circulation J 1999;299: Bifurcated Stent-GraftVanguard 를이용한 복부대동맥류의경관적치료 심원흠 1 최동훈 1 윤영섭 1 이도연 2 장병철 3 Bifurcated Stent-GraftVanguard for the Endovascular Treatment of Abdominal Aortic Aneurysm Won-Heum Shim, MD 1, Donghoon Choi, MD 1, Young Sup Yoon, MD 1, Do-Yun Lee, MD 2 and Byung-Chul Jang, MD 3 1 Cardiology Division, 2 Radiology, 3 Cardiovascular Surgery, Yonsei Cardiovascular Center, Yonsei University, Seoul, Korea ABSTRACT PurposeThe purpose of this study was to evaluate the safety, feasibility and effectiveness of an endoluminallyplaced bifurcated stent-graft (Vanguard) for the treatment of infrarenal abdominal aortic aneurysm (AAA). MethodsTransluminal endovascular stent-graft placements were attempted in 29 patients (28 male, mean age 697 years) with AAAs involving the common iliac arteries from Aug to Jan Endovascular therapy was performed in the cardiac catheterization laboratory with epidural anesthesia. One side of the femoral artery was opened by surgical cutdown for the bifurcated stent-graft entry and the other side was punctured percutaneously for the straight stent-graft. Computed tomography and/or intraarterial angiography were performed during an average follow-up of 10 months (218 months). ResultsPrimary success rate was 75.9% (22 of 29 patients) and the overall success rate was 79.3% with successful correction of one perigraft leak. Twenty patients (69.0%) had significant coronary artery disease. There were two technical failure cases, the one was tortuous iliac vessel with spasm, the other was disconnection of the stent-graft connecting portion. Complications related to procedure occurred in 13.8% of patients (4 of 29 patients) and two of these four patients had procedure-related mortality because of acute renal failure following contrast overdose and sepsis after operation. ConclusionsEndovascular treatment of infrarenal AAA with bifurcated stent-graft (Vanguard ) is effective, feasible and relatively safe. However, further investigation for the outcome, complication and long-term follow-up are needed. Korean Circulation J 1999;292: KEY WORDSAbdominal aortic aneurysm Bifurcated Stent-graft Endovascular treatment. 서 론 907

2 연구대상및방법 908 A B Fig. 1. Stent-Grafts used for the endoluminal treatment of infrarenal abdominal aortic aneurysms. AThe main body is implanted with use of a delivery system inserted through a surgical cutdown. BThe contralateral iliac limb is inserted percutaneously. Korean Circulation J 1999;299:

3 A B Fig. 2. Implantation of a bifurcated stent-graft in a 72-year-old patient with an infrarenal abdominal aortic aneurysm with involvement of the both internal iliac arteries. AInitial angiography and computed tomography obtained before the procedure show an infrarenal abdominal aortic aneurysm with involvement of the both internal iliac arteries. And follow-up computed tomography confirms the exclusion of the aortic aneurysmal sac. BSchematic treatment method for the infrarenal abdominal aortic aneurysm with involvement of the both internal iliac arteries. 연구결과 909

4 고안 910 Korean Circulation J 1999;299:

5 연구배경 : 요약 대상및방법 : 결과 : 911

6 결론 : 중심단어 감사문 REFERENCES 1) Isselbacher EM, Eagle KA, Desanctis RW. Abdominal aortic aneurysms. In Braunwald E, editors. HEART DISE- ASE A textbook of cardiovascular medicine. 5th ed. W.B. Saunders company1997. p ) Ernst CB. Abdominal Aortic Aneurysm. N Eng J Med ) Harris LMm, Faggidli GL, Fiedler R, Curl GR, Ricotta JJ. Ruptured abdominal aortic aneurysms Factors affecting mortality rates. J Vasc Surg ) Brown OW, Hollier LH, Pairolero PC, Kazmier FJ, Mc- Cready RA. Abdominal aortic aneurysm and coronary artery disease. Arch Surg ) Piquet P, Rolland PH, Bartoli JM, Trainer P, Moulin G, Mercier C. Tantalum-Dacron coknit Stent for endovascular treatment of aortic aneurysms. A preliminary experimental study. J Vasc Surg ) Dake MD, Miller C, Semba CP, Mitchell RS, Walker PJ, Liddel RP. Transluminal placement of endovascular Stentgrafts for the treatment of descending thoracic aortic aneurysms. N Eng J Med ) Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg ) Mialhe C, Amicabile C, Becquemin JP. Endovascular treatment of infrarenal abdominal aneurysms by the Stentor system: Preliminary result of 79 cases. J Vas Surg ) Dotter CT. Transluminally-placed coilspring endarterial tube grafts. Long-term patency in canine popliteal artery. Invest Radiol ) Balko A, Piasecki GJ, Shah DM, Carney WL, Hopkins RW, Jackson BT. Transfemoral placement of intraluminal polyure-thane prosthesis for abdominal aortic aneurysm. J Surg Re-search ) Lawrence DD, Charnsangavej C, Wright KC, Gianturco C, Wallace S. Percutaneous endovascular graft: Experimental evaluation. Radiol ) Marin ML, Veith FJ, Panetta TF, et al. Percutaneous transfemoral insertion of a Stented graft to repair a traumatic femoral arteriovenous fistula. J Vasc Surg ) Cragg AH, Dake MD. Percutaneous graft placement. JVIR ) May J, White G, Waugh R, Yu W, Harris J. Transluminal placement of a prosthetic graft-stent device for treatment of subclavian artery aneurysm. J Vasc Surg ) White GH, Yu W, May J, Stephen MS, Waugh RC. A new nonstented balloon-expandable graft for straight or bifurcated endoluminal bypass. J Endovasc Surg ) Chutter TAM, Green RM, Ouriel K, Fiore WM, DcWeese JA. Transfemoral endovascular aortic graft placement. J Vasc Surg ) DY Lee, BC Chang, WH Shim, SY Cho, NS Chung, HM Kwon, et al. Transluminal endovascular Stent-graft for the treatment of aortic aneurysm. J Korean Radiological Society ) WH Shim. Non-surgical treatment of abdominal aortic aneurysm. Journal of the Korean Medical Association ) DH Choi, WH Shim, YS Yoon, SY Kim, KJ Park, DY Lee, et al. Transluminal Endovascular Stent-Graft for the Treatment of Vascular Lesions. The Korean Circulation Journal supp II ) Blum U, Voshage G, Lammer J, Beyersdorf F, Tollner D, Kretschmer G, et al. Endoluminal stent-grafts for infrarenal abdominal aortic aneurysms N Engl J Med ) Moore WS, Vescera CL. Repair of abdominal aortic aneurysm by transfemoral endovascular graft placement. Ann Surg ) Lumsden AB, Allen RC, Chaikof EL, Resnikoff M, Moritz MW, Gerhard H, et al. Delayed rupture of aortic aneurysms following endovascular stent grafting. Am J Surg Korean Circulation J 1999;299:

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12.ÀÇÇÐ°�ÁÂc10«±âÃµ-42~552 Endovascular Aneurysm Repair Kee Chun Hong, M.D. Jang Yong Kim, M.D. Yong Sun Jeon M.D. Department of Surgery Radiology* Inha University College of Medicine & Hospital E mail : keechong@inha.ac.kr Abstract