Experience of Endovascular Aneurysm Repair in Abdominal Aortic Aneurysm

ABSTRACT

PURPOSE: We report our experience of endovascular aneurysm repair (EVAR) in Korea. METHODS: The medical records of 11 EVARs between 1996 and 2004 in the Samsung Medical Center were reviewed retrospectively. RESULTS: The abdominal aortic aneurysm (AAA)s were classified into 6 type A, 2 type B, 1 type C, 1 type D and 1 type E according to the anatomy. The indication of EVAR were the patient's choice (7) and the high surgical risk (4). The stent grafts used were Vanguard (4), AneuRX (3), Nitis-s (3), and the S&G (1). The mean time of the procedure, intensive care unit and post-procedral hospital stay were 3.9+/-0.8 hours, 25.1+/-13.6 hours and 7.9+/-2.8 days. There was no procedure related complications. After angiography had been performed, 1 type I endoleak and 5 type II endoleaks were found. The type I endoleak was treated with an extension of the stent-graft. The 4 type II endoleaks disappeared while the 1 type II endoleak was treated with glue embolization. During the follow up, 1 type I, 3 type II, and 3 type III endoleak were found. The type I endoleak was treated with glue embolization and the 3 type II endoleaks disappeared. The 2 type III endoleaks were treated with aortounilateral stent-graft insertion and a femorofemoral bypass, followed by a conversion to open repair. The 1 patient with the type III endoleak refused treatment. There was no 30-day mortality but 5 late mortalities. The causes of death were 2 myocardiac infarctions, 1 hepatoma, 1 pneumonia and 1 sepsis. CONCLUSION: EVAR can be performed safely in high-risk patients but additional procedures may be needed during the follow-up. EVAR can be alternative option for the treatment of AAA in Korea if the experience of EVAR increases and the results improve.