Endovascular covered stent graft exclusion and prosthetic vessel replacement for treatment of abdominal aortic aneurysm: Comparison of 1-year follow-up outcomes

Chenxi OUYANG; Jianyong LIU; Bi JIN

ABSTRACT

BACKGROUND:

Conventional prosthetic vessel replacement has been gradually replaced by endovascular covered stent graft exclusion in the treatment of abdominal aortic aneurysm (AAA).However,whether it has advantages over conventional prosthetic vessel replacement in clinical curative effects and biocempatibility produced in the implantation of new type of biomaterials remains unclear.

OBJECTIVE:

To compare the curative effects and complications of endovascular covered stent graft exclusion and prosthetic vessel replacement in the treatment of AAA.

DESIGN:

A controlled observation analysis.

SETTING:

Department of Vascular Surgery,Wuhan nion Hospital.

PARTICIPANTS:

Forty-two patients with AAA (renal artery not involved) who received the treatment in the Department of Vascular Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology between September 2001 and July 2006,were recruited in this study.They were all confirmed by CT angiography (CTA) and other examinations.According to the selected operative way,patients were allocated into interventional therapy group (n =17) and conventional therapy group (n =25).In the interventional therapy group,the patients,including 16 males and 1 female,were averaged (68±10)years old,and their mean tumor diameter was (6.4±1.3) cm.In the conventional therapy group,the patients,including 23 males and 2 females,were averaged (64±9) years,and their mean tumor diameter was (6.2±1.1) cm.Significant difference did not exist in the baseline material between two groups (P ＞ 0.05).This study was approved by the Hospital Ethics Committee.Written informed consents were obtained from all the patients.

METHODS:

In the interventional therapy group,patients underwent ndovascular covered stent graft exclusion by an interventional means.After being generally anesthetized,patients were dissected at unilateral femoral artery.Under the perspective condition,a covered stent graft was placed at a proper position with a forwarder,and then it was released and expanded.Following the position and xpansion of a covered stent being examined by CTA,femoral artery was anastomosed and incision was closed.If arteria iliaca was involved,then another covered stent was implanted from contralateral femoral artery and connected to stem.In the conventional therapy group,patients underwent prosthetic vessel replacement by a conventional means.Postoperatively,patients in the two groups all received anti-inflammation,anti-coagulation and other symptomatic and supportive treatments necessarily.MAIN OUTCOME

MEASURES:

① Postoperative complications of patients in two groups.② Recovery was observed by B-ultrasonography and CTA examination 1,3,6 and 12 months after operation.③ Follow-up of biocompatibility of biomaterials and host during 1 year postoperatively.

RESULTS:

Forty-two patients participated in the finial analysis.①Patients who exhibited pulmonary infection and renal function deterioration in the interventional therapy group were fewer than those in the conventional therapy group (P ＜0.05).② In the interventional therapy group,patients with covered-stent graft displacement,aortic injury and hematoma formed at the puncture point of femoral artery were not found.In the conventional therapy group,one patient died of acute large-area myocardial infarction at the 6th week postoperatively,and patients,who suffered from stomal leakage,prosthetic vessel thrombogenesis and infection,etc.,were not found.③ Neither obvious inflammatory reactions in the peripheral tissue of prosthetic vessel nor thrombogenesis in the prosthetic vessel was found in patients of two groups.It was demonstrated that both covered stent graft and prosthetic vessel had good biocompatibility.

CONCLUSION:

Endovascular covered stent graft exclusion can treat AAA due to its less surgical trauma,rapid postoperative recovery,good biocompatibility and other advantages.