Seven years' single center experience of Powerlink unibody bifurcated endograft for endovascular aortic aneurysm repair.

AIM

To assess the 7-year results of endovascular aortic aneurysm repair using the Powerlink unibody bifurcated endovascular stent-graft in our single center.

METHODS

A prospective, nonrandomized trial was conducted in our unit within 7 years. Endovascular aortic aneurysm repair (EVAR) was planned, performed and followed-up by a fixed endovascular specialized group, including 2 vascular surgeons and 1 interventional radiologist. All the relative data were input into the SPSS statistical analysis software. All patients received abdomen X-ray plain films and CTs or duplex before discharge and 1 month, 6 months, 1 year after discharge, and then annually.

RESULTS

From February 1999 to September 2006, a total of 378 abdominal aortic aneurysms (AAAs) patients were intended to treat with Powerlink device, 372 cases were implanted successfully, the technical success rate was 98.4%. The average operation time was 66 min (range, 35-150 min). The late 210 cases (56.5%) were implanted sitting on the aortic bifurcation, the other 162 early cases (43.5%) were not implanted sitting on the aortic bifurcation, proximal cuff was implanted in 209 cases (56.2%), and distal limb extension was used in 42 cases (11.3%), 22 cases (5.9%) received Palmaz stent. One hundred and ninety- four cases (52.2%) had infrarenal fixation, 178 cases (47.8%) had suprarenal fixation. Intraoperative complications included immediate conversion in 6 cases (1.6%), primary proximal type I endoleak in 8 cases (2.2%), primary distal type I endoleak in 2 cases (0.5%), type II endoleak occurred in 20 cases (5.4%). Mean follow-up was 26.7 months (range 1 month 7 years). Postoperative complications included secondary type I endoleaks in 10 cases (2.7%), secondary type II endoleaks in 9 cases (2.4%), limb occlusion in 8 cases and limb stenosis in 5 cases, endograft limb kinking/twisting in 2 cases, partial renal infarction in 9 cases (2.4%). A total of 7 cases (1.9%) had distal migration and all 7 cases were not implanted sitting on the aortic bifurcation. Post-EVAR conversion occurred in 6 cases (1.6%). There were a total of 18 deaths (4.8/%) and 6 deaths (1.6%) within 30 days.

CONCLUSIONS

The Powerlink device is safe and effective in preventing AAA rupture in mid-term. It proved simple and easy for size choice. The unique design of this device may confer some advantages in terms of durability. The distinct anatomic fixation of stent-graft sitting on the aortic bifurcation simplifies the deployment procedures and minimizes the potential of distal migration. Prospective longer follow-up in multicenter randomized controlled larger series is necessary to confirm the encouraging outcomes.