Outcome of Tubular Aortoaortic Endografts in Infrarenal Aneurysmal Disease and Penetrating Abdominal Aortic Ulcers-a Long-Term Follow-up.

BACKGROUND: We describe the long-term follow-up of patients treated for infrarenal abdominal aortic aneurysms and penetrating ulcers by placement of tubular aortic endografts at our institution from 2010 to present. METHODS: This is a retrospective study using clinical data of patients treated from 2010 to present by placement of either a single aortic tubular endograft or by two overlapping endografts, using the "trombone technique." Aortic dimensions were measured from the preoperative computed tomography scans using three-dimensional reconstruction. The primary outcome was aortic reintervention. Secondary outcomes were aorta-related mortality, endoleaks, and postoperative complications. RESULTS: Twenty-eight patients were identified. Nine patients were treated for saccular aneurysms, and nineteen patients presented with penetrating aortic ulcers. The median follow-up was 31 months (range: 4-99). Twenty patients were treated with a single tubular device, while eight patients were treated using two overlapping devices. Aortic reintervention occurred in four patients (14.3%), all were treated initially with a single device. No aortic mortality occurred during follow-up. No aneurysm ruptures occurred. Four patients died during follow-up of unrelated causes. Endoleaks occurred in ten patients (35%). Five endoleaks were of type I (17.8%), of which three were of distal type (10.7%). Five endoleaks were of type II (17.8%). Shorter distal landing zones than 20 mm were present in two of the cases with a distal type I endoleak (P = 0.0232). Postoperative complications occurred in three (10.7%) patients including one myocardial infarction and two wound complications from a surgical cut down in the groin. CONCLUSIONS: The technique shows an acceptable postoperative complication rate but is characterized by high rate of occurrence of type I endoleaks and aortic reintervention in our series. Endovascular techniques using tubular endografts should be limited to cases with long proximal and distal sealing zones. The trombone technique seems preferable.

Successful Endovascular Repair of a Penetrating Aortic Ulcer in Bacterial Aortitis.

Infective aortitis (IA) and penetrating aortic ulcer (PAU) impending for rupture represent 2 hostile life-threatening conditions. Simultaneous presentations of these rare entities can be considered an exception. The pleomorphic clinical presentation and the multifactorial etiology require a multidisciplinary approach to reach a correct diagnosis and an urgent treatment. We report the case of a 65-year-old patient presented with acute abdominal pain and septic shock secondary to a bacterial aortitis and penetrating ulcer of abdominal aorta. Unfit for surgery due to severe comorbidities, he was treated by means of a tubular endograft and long-term antibiotic therapy. A rapid improvement of clinical conditions was observed during the subsequent hospital stay. Complete regression of aortic involvement was demonstrated after 1 year. In conclusion, for selected patients affected by IA and PAU an endovascular approach associated to long-term antibiotic therapy may be safe and effective.