Adjunctive procedures for the treatment of proximal type I endoleak: the role of peri-aortic ligatures and Palmaz stenting. 
To investigate the feasibility, efficacy, and long-term effects of peri-aortic ligatures and Palmaz stenting used to treat proximal type I endoleak after endovascular repair (EVR) of abdominal aortic aneurysm (AAA).  An 8-year single-center experience with proximal type I endoleak was reviewed; the records of the 55 identified cases were examined to ascertain the methods of treatment used.  Among these, all 22 patients who were treated with peri-aortic ligatures and Palmaz stenting were segregated for analysis.  The 22 patients (14 men; mean age 74.6 years, range 66-85) with proximal type I endoleak (18 early, 4 late) selected for analysis underwent 23 secondary procedures: 15 involving peri-aortic ligatures and 8 Palmaz stent implantations.  Of the 18 early endoleaks, 11 were treated intraoperatively and 7 were observed.  Ten (45%) patients died within 30 days of endoleak treatment: 8 had early endoleaks.  Five of the 10 deaths occurred in patients successfully treated with peri-aortic ligatures (3/10) or Palmaz stenting (2/7).  The 12 (54%) surviving patients suffered no aneurysm-related deaths or secondary endoleaks over a median follow-up of 20 months (range 4-75).  Endoleak is an important mode of failure after endovascular repair.  Peri-aortic ligatures and Palmaz stenting are feasible techniques for the treatment of proximal endoleak; however, the perioperative mortality of peri-aortic ligatures was higher when compared with other less invasive techniques.  In contrast to other therapeutic options, these methods are more effective in the short and medium term.