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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

A Journal on Vascular and Endovascular Surgery


Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2003 September;10(3):223-237

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English, Italian

Standard open surgical repair versus endovascular repair of anastomotic abdominal aortic aneurysms

Bracale G. 1, Porcellini M. 1, Spinetti F. 1, Cecere D. 1, Bracale U. M. 1, Del Guercio L. 1, Jausseran J. M. 2

1 Cattedra di Chirurgia Vascolare, Università degli Studi di Napoli “Federico II”, Napoli, Italy 2 Service de Chirurgie Cardio-Vasculaire, Hopital-Saint Joseph, Marseille, France


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Background. The ­study ­aimed to com­pare the endo­vas­cu­lar ­stent-­graft tech­nique ­with ­open ­repair of anas­to­mot­ic aor­tic aneu­rysms fol­low­ing aor­to-femo­ral recon­struc­tions.
Methods. Nine ­patients (­mean age = 62.7 ­years; ASA II: 5 ­patients, ASA III: 3 ­patients ASA IV: 1 ­patient) ­were treat­ed ­with stan­dard ­open ­repair (­group 1) and 14 ­patients at ­high sur­gi­cal ­risk (­mean age=71.8 ­years; ASA II: 2 ­patients, ASA III: 3 ­patients, ASA IV: 9 ­patients) ­were treat­ed by endo­vas­cu­lar ­stent-graft­ing (­group II), in ­both ­groups for non-infect­ed anas­to­mot­ic aneu­rysms locat­ed in the abdom­i­nal aor­ta. One ­patient in the sur­gi­cal ­group had ­frank and 1 had cov­ered rup­ture of the aneu­rysm sac. In addi­tion, 1 anas­to­mot­ic ­iliac aneu­rysm was exclud­ed by ­means of a ­tube ­graft and 7 anas­to­mot­ic femo­ral aneu­rysms ­were ­repaired by sur­gery.
Results. Surgical treat­ment was resec­tion of the anas­to­mot­ic aor­tic aneu­rysm and replace­ment ­with a new ­graft. The oper­a­tive mor­bid­ity ­rate was 25%; mor­tal­ity ­rate 14.3% (1 out of 7) for ­patients ­with ­intact aneu­rysm and 50% (1 of 2) for ­patients ­with rup­tured aneu­rysm. All endo­vas­cu­lar inter­ven­tions ­were com­plet­ed sat­is­fac­tor­i­ly, ­with no ­open con­ver­sion; an ­acute ­graft throm­bo­sis ­occurred in 1 ­patient (7.1%), who ­required a femo­ro-femo­ral cross­over ­graft. There ­were no pro­ce­dure-relat­ed ­deaths, and com­pli­ca­tions (14.3%) includ­ed 1 per­i­op­er­a­tive tran­sient cere­bral ische­mia and 1 ­case of post­op­er­a­tive jaun­dice. During a ­mean fol­low-up peri­od of 3.8 ­years (14-81 ­months) and 4.3 ­years (11-79 ­months), respec­tive­ly, re-op­er­a­tion has ­been ­required in 14.3% of ­patients ­after stan­dard oper­a­tive ­repair and in 21.4% ­after endo­vas­cu­lar ­repair for treat­ment of ­limb occlu­sion or ­graft migra­tion. There was 1 ­late con­ver­sion to ­open ­repair 46 ­months ­after the ­initial pro­ce­dure. The ­late mor­tal­ity ­rates ­were ­almost iden­ti­cal (28.6% ver­sus 21.4%) in the two ­groups.
Conclusions. Endoluminal ­repair is a ­less inva­sive treat­ment meth­od and pro­vides ben­e­fits to eld­er­ly, ­high-­risk ­patients. Because of con­cerns relat­ed to its ­long-­term effec­tive­ness, elec­tive stan­dard sur­gi­cal ­repair can ­still ­play a ­role for young­er, low­er-­risk ­patients.

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