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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

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Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2003 March;10(1):27-40

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English, Italian

Mid-term results of endovascular treatment of abdominal aortic aneurysms

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)


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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.

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