Total amount: € 0,00
HOW TO ORDER
ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 2003 September;10(3):223-237
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
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.