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Italian Journal of Vascular and Endovascular Surgery 2004 June;11(2):87-91


lingua: Inglese

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.

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