Use of a ringed intraluminal graft in the operative management of abdominal aortic aneurysms

The efficacy of a non‐sutured technique of anastomosis has been assessed in 20 patients who had bifurcated grafts inserted for aneurysms of the infrarenal aorta. The grafts had rigid Dacron‐covered metal rings incorporated at each end and the anastomoses were effected by securing these rings within the lumen of the vessel with a firmly tied Dacron tape. In order to allow access of the ring to the lumen of the aorta it was necessary to employ an intraluminal occlusion balloon catheter for proximal control. The patients included in the study formed a particularly high risk group. There were 12 emergency and 8 elective procedures. The mean duration of the operations was 134±34 min (± s.d.); the mean blood loss during surgery was 3498±2660ml (±s.d.) and the mean length of inpatient stay after operation was 16±13 days (±s.d.). There were eight postoperative deaths and post‐mortem examination, which was allowed in six cases, showed satisfactory appearances of the grafts and anastomoses. The surviving patients have remained free from complications for up to 18 months after operation. A non‐sutured technique is possible for most aortic anastomoses but is of limited applicability for iliac and more distal anastomoses. With further technical refinements an intraluminal graft with a non‐sutured aortic anastomosis may become a valuable alternative to the conventionally sutured prosthesis in the management of ruptured abdominal aneurysms.