Single center experience of endovascular abdominal aortic aneurysms repair

Background

To present own results of endovascular repair of abdominal aortic aneurysms (EVAR AAA) using different techniques in patients with challenging anatomy and a wide range of different comorbidities being therefore unfit for open surgery due to high perioperative risk value.

Methods

Since May 2010 51 patients with a median age of 69 years were included. Among them there were 32 (89%) men and 4 (11%) women. 28 (78%) patients had infrarenal localization of abdominal aortic aneurysms, 8 (22%) patients had juxtarenal localization of AAA. In 34 patients (94%) abdominal aortic aneurysms were etiologicaly atherosclerotic and in 2 patients (6%) it was Marfan syndrome to be the definite reason for aneurysmatic disease.

The maximum dimensions of the abdominal aorta averaged 59 ± 18mm. All patients had challenging anatomy: short and severely angulated and/or conic proximal aortic neck, unsuitable distal ”landing zone”, thrombus, calcification and complicated morphology, complex aneurysms and dissections of iliac and femoral arteries.

Results

All patients got epidural/spinal anesthesia. 4 patients with juxtrarenal AAA were operated on with fenestrated endoprostheses and in 4 patients- “chimney” technique was used (including 1 patient with “sandwich” technique). In cases of complicated morphology of iliac arteries subclavian/axillary access was used. Also we made femoro-femoral or femoro-popliteal bypass in 3 patients with need of lower extremities revascularizaton. Still 2 patients revealed acute in-stent thrombosis due to dissection of distal part of external iliac artery and due to crushed chimney-stent successfully managed with balloon angioplasty and supplementary stent implantation. Hospital mortality was 2,8% (1 patient died due to acute MI on 5 day after procedure). 30-day’s mortality was 2,8% as well.

Conclusion

EVAR is the promising alternative to conventional open aortic repair.