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Online ISSN 1827-1847
De Blasis G. 1, Passalacqua G. 2, Bafile G. 1, D’Elia M. 1, Turco G. L. 1, Scalisi L. 1, Pinelli M. 1, Petitta S. 1, Filauri P. 2
1 Unità Operativa di Chirurgia Vascolare Ospedale SS. Filippo e Nicola, Avezzano (AQ)
2 Servizio di Radiologia Vascolare Interventistica Ospedale SS. Filippo e Nicola, Avezzano (AQ)
Background. Report the mid-term results of our study on endovascular treatment of abdominal aortic aneurysms.
Methods. From December 1997 to September 2001, 140 patients with abdominal aortic aneurysms were treated at our unit, 85 (60.8%) of which (81 men; age range: 51-87 years; mean age: 73.3) underwent endovascular procedures. The mean maximum diameter of the aneurysm was 5.71 cm (range: 3.71-13). Five different types of stents were implanted in epidural anesthesia in 84.7% of cases (72/85), in general anesthesia in 5.8% (5/85) and local anesthesia in 8 (9.4%), which is being increasingly used in treatment at our unit.
Results. Perioperative (within 30 days). Correct stent placement without conversion to laparotomy was achieved in all cases. Accidental covering of a renal artery, without causing renal failure, occurred in 1 case. Perioperative mortality was 2.4% (2 cases) due to comorbidity; early endoleaks developed in 20 cases (23.5%) which remitted within 1 month, except 1 which resolved within 4 months postoperative. In 5 cases (5.8%) early thrombosis of a stented branch developed. Mid-term. Mean follow-up period was 14.92 months; overall compliance was high (92.9%; 79/85). End points were: mortality, rupture, endoleaks, thrombosis, stent alterations, repeated intervention during follow-up. During follow-up 15 deaths were recorded: 2 due to causes associated with surgical treatment, 1 because of cerebral hemorrhage during fibrinolysis, the other due to rupture. Other causes included late leaks (12; 15%), branch thrombosis (2; 2.5%), stent alterations (29 events in 14 patients; 17.7%), all of which except 1 occurred with the same type of stent. Eleven (13.9%) repeated interventions were performed in 8 patients (10%). These were carried out via an endovascular approach except in 1 case of thrombosis treated with femorofemoral cross-over bypass.
Conclusions. Endovascular treatment of abdominal aortic aneurysms is safe and effective in the short term, however, the mid-term results are less satisfactory. Even so, with attentive follow-up problems can be diagnosed in timely fashion and resolved with endovascular treatment.
language: English, Italian