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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2004 June;11(2):87-91
Low-invasive treatment of abdominal aortic aneurysm endovascular repair complications
Gattuso R., Dionisi C. P., Laurito A., Siani A., Jabbour J.
2nd Unit of Vascular Surgery “La Sapienza” University, Rome, Italy
Aim. This study assesses low-invasive treatment to repair complications after endovascular surgery for abdominal aortic aneurysms (AAA).
Methods. From September 1998 through March 2002, 60 patients with AAA received an endovascular prosthesis. Of these, 45 were classified in ASA III and 15 in ASA IV. Preoperative workup included spiral computed angiotomography and centimetered catheter angiography. Endoprosthesis placement was performed in 52 (86.6%) cases using general anesthesia and in 8 (13.4%) using epidural anesthesia. Surgical preparation of both femoral arteries was carried out in 33 patients; transverse arteriotomy was performed on the side where the main body of the prosthesis was introduced. Five types of endoprostheses were used: 29 Excluder, 24 Vanguard II, 3 Anaconda, 3 Talent, 1 Endologix. During the follow-up period (range, 2-42 months; mean, 22 months), all patients underwent routine control examination with Doppler color ultrasonography with and without contrast medium, and spiral computed angiotomography at 1, 3, 6, 12 months and every 12 months thereafter. Digital angiography was performed in only one case of complications.
Results. No patients were lost to follow-up nor were deaths recorded. In 1 case (1.6%), a conventional surgical procedure was performed because an aortoenteric fistula had formed 22 months after the first operation. Other complications included occlusion of a prosthetic branch in 3 cases (5%), renal artery obstruction in 1 (1.6%), endoleaks in 6 (10%). Of the first 3 cases, 1 was treated with thrombolysis and secondary stenting, and the 2 others received a femorofemoral crossover bypass; in 4 cases of endoleaks, 1 was repaired with laparoscopic ligature of the inferior mesentery artery, 1 with lumbar embolization, 1 with placement of a coated stent, and 1 with placement of an additional cuff. The primary success rate was 81.6% (49 of 60), with a complication incidence of 18.3% (11 of 60); the secondary success rate was 93.3% (56 of 60), with an unresolved complication incidence of 6.6% (4 of 60).
Conclusion. The results in our case series indicate that, in patients with high surgical risk, endovascular surgery of subrenal abdominal aortic aneurysms is a valuable alternative to conventional procedures. Low-invasive treatment of complications demonstrated the flexibility and reliability of endovascular techniques. Advances in technology will undoubtedly further reduce the incidence of complications and help refine the low-invasive procedures available to treat them.