ABSTRACT
To present our experience with elective Endovascular Aneurysm Repair [EVAR] cases done at King Hussein Medical Center, Amman, Jordan. This is a retrospective chart review of elective Endovascular Aneurysm Repair procedures done during the period of January 2004 to November 2010. One hundred seventeen patients [91 males and 26 females] with a median age of 71 [range 52 to 79] successfully underwent the procedure. Devices used included Endurant [Medtronic AVE, Santa Rosa, Calif], Zenith [Cook Inc, Bloomington, Ind], Talent [Medtronic], and Excluder [W.L. Gore, Flagstaff, Ariz]. Configurations included, 113 [96.6%] aorto-bi-iliac, three [2.6%] aorto-uni-iliac with femoro-femoral crossover graft, and one [0.8%]straight tube graft. Most patients [n=85, 72.6%] scored 3/4 in the American Society of Anesthesia [ASA] scale and had significant comorbidities. CT angiography was the main imaging modality used in both preplanning stage and follow up. Primary outcome measures included overall mortality and freedom from aneurysm rupture. Secondary outcome measures included access site complications, graft limb complications, and endoleaks. No conversions to open surgical repair or ruptures occurred post graft implantation. A total of 14 [12.0%] patients underwent re-intervention most of which were for access site problems. These included wound hematoma treated conservatively [n=5, 4.3%], wound infection treated with drainage and antibiotics [n=3, 2.6%], and vessel dissection or occlusion needing surgical repair [n=2, 1.7%].Graft limb complications included occlusions needing femoro-femoral bypass [n=2, 1.7%]. A total of 27 [23.0%] endoleaks were diagnosed: three [2.6%] were type I and were managed with ballooning and proximal extension in one case, 1[0.9%] type 3 managed with an iliac limb extension, and 23 [19.7%] type 2 endoleaks managed conservatively. The mean in hospital length of stay [LOS] was 3.1 days [range 2-7] while the mean follow up was 16.2 months [range 6-58]. Overall patient mortality during the study period was eight [6.8%] patients while in hospital mortality was four [3.4%]. All late deaths were aneurysm unrelated. Endovascular Aneurysm Repair is technically feasible and effective in aneurysm exclusion and preventing rupture. It offers major advantages over open aneurysm repair including reduced early mortality, hospital stay, and use of intensive care facilities. However, issues of cost effectiveness and late mortality in our setting are still to be resolved
ABSTRACT
Thirty six cases of percutaneous biopsies for spinal lesions were carried out at King Hussein Medical Center in the period January 1995 till January 1999 in an attempt to obviate the need for open surgery, and to reduce the mortality and morbidity rates associated with open back surgery. All the patients who were subjected to percutaneous biopsies had localised spinal pathology on computed tomography [CT] scan or magnetic resonance imaging [MRI]. All the biopsies have been performed under local anesthesia. Bi-planar fluoroscopy control was used as radiology guidance in lumbar and cervical biopsies. CT controlled biopsies were used for cervical, dorsal, and sacral lesions. The Ackerman trephine needle was used in all patients. Several core biopsies for pathological examination and culture were obtained from all patients. No serious complications were registered. Out of the 36 cases only seven cases were not diagnosed using percutaneous biopsy. Percutaneous biopsy proved to be safe, quick, and a reliable alternative to open surgery biopsy in this respect