Immediate and Mid-Term Outcomes of the Endovascular Stent-Graft Treatment of Abdominal Aortic Aneurysm

BACKGROUND AND OBJECTIVES: Although the standard management of an abdominal aortic aneurysm (AAA) is surgery, endovascular stent-graft treatment is more attractive for patients with significant co-morbid conditions. We evaluated the immediate and mid-term outcomes for the endovascular treatment of AAA. SUBJECTS AND METHODS: Between November 1996 and August 2004, 59 patients with an AAA (53 males, mean age 68.0+/-9.6 years, 3 cases with ruptured AAA) underwent an endovascular stent-graft repair at our institute. All patients were evaluated by an angiography, taken just after the completion of the procedure and at followed up with computed tomography (CT) at 1, 3, 6 and 12 months, and yearly thereafter. RESULTS: Technical success was achieved in 54 of the 59 patients (91.5%). The periprocedural mortality rate was 3.4% (2 of the 59 patients). A primary endoleak was found in 12 patients (20.3%)(type I; 9 patients, type II; 2 patients, type III; 1 patient), 2 of which required subsequent surgical conversion. Spontaneous resolution of an endoleak was seen in 4 patients (33.3%). The average follow-up period of 57 patients was 27.5 months (range from 72 days to 2581 days). In 8 patients (14.0%), a newly developed secondary endoleak was documented. A total 14 patients (23.7%) died during the follow-up period (rupture; 3, operation-related sepsis; 3, unrelated causes; 3, cardiac arrest; 1, unknown causes; 4). The cumulative survival rates at 30 days and at 1 and 2 years were found to be 93.0, and 85.7 and 76.3%, respectively, using Kaplan-Meier methods. Secondary intervention was required in 12 patients (21.8%), and surgical conversion in 4 (6.8%), with 2 (3.4%) requiring conversion to open surgery immediately after the intervention. In those with technical success, without endoleaks and graft failure, the survival rate during follow-up was higher (97.1%; rate with the exception of unrelated cause of death) than that of all the patients. CONCLUSION: The immediate and mid-term results suggest that the endovascular treatment of an AAA is technically feasible and effective. There was higher mortality and morbidity in primary and newly developed endoleak cases; therefore, proper selection of cases, according to the anatomical and clinical criteria, is essential, with meticulous regular follow-ups being critical for the optimal endovascular treatment of an AAA.

Favorable Late Outcome of Endovascular Abdominal Aortic Aneurysm Repair

BACKGROUND AND OBJECTIVE: Although the endovascular method of treating abdominal aortic aneurysms (AAA) shows good early results and benefits, the late outcome of this treatment remains uncertain. This study evaluated the late outcome following an endovascular AAA repair. SUBJECTS AND METHODS: Thirty-three patients that had undergone an endovascular AAA repair at our institute were evaluated. The results of the treatment were evaluated by an angiography, taken just after the completion of the procedure, and by contrast-enhanced CT scans at 1, 3, 6 and 12 months, and annually thereafter. RESULTS: The patient's characteristics were as follows: 29 (88%) were male, 19 (58%) had coronary artery disease and 7 (21%) had renal insufficiency. A technical success was achieved in 31 patients (94%), with primary endoleaks in two. Two patients (6.1%) died within 1 month of the procedure, both at an elderly age, with high risk. There was 1 (3%) incidence of early complications that required treatment. During the 28 month follow-up period, 6 patients (20%) needed a secondary procedure. Endoleaks remained in 4 patients, and the size of aneurysm increased in 3 patients. Four patients died during follow-up, and two had an endoleak. The cause of death was not related to cardiovascular diseases in the other two patients. The event free survival at 24 months was 72%. CONCLUSION: The late outcome after an endovascular AAA repair was favorable. However, a secondary procedure was needed, and endoleaks observed, in half of the patients that died during follow-up. Therefore, regular evaluation of aneurysms and the management of endoleaks are very important for a favorable late outcome in endovascular AAA repair patients.