Endoluminal repair of abdominal aortic aneurysms using the trombone technique

This paper describes a method of endoluminal repair of abdominal aortic aneurysms (AAA) using two overlapping, non-stented endografts, the double-tube endograft or trombone technique. Between May 1992 and December 1994, endoluminal repair of AAA was undertaken in 65 patients. The trombone technique was used in 12 patients between July 1993 and July 1994. The balloon expandable endoluminal graft used in this technique (Sydney endograft) does not require adjunctive use of a vascular stent because its unique construction incorporates metallic attachment devices within the graft material. Patients were investigated pre-operatively by calibrated angiogram and angio-computed tomography (CT) scan and their aneurysms were considered suitable for transfemoral implantation of a straight tube-graft. Intraluminal deployment of the double graft was successfully achieved in all 12 patients. Postoperative angio-CT scan revealed extravasation of contrast from the lumen into the aneurysmal sac in one patient. Another patient developed evidence of extravasation of contrast into the aneurysmal sac at six-month follow-up. Both patients then received conventional open repair for AAA. In the remaining 10 patients, the aneurysms were successfully excluded from the circulation. There was no extravasation of contrast at the junction of the two overlapping grafts and no deaths in this group. All 12 patients were followed by clinical examination, duplex scan and CT scan. As of January 1995, the minimum period of follow-up was six months and all patients remained well. These preliminary results demonstrate that AAAs that are suitable for endoluminal tube-graft repair may be successfully treated by the double endograft or trombone technique.