Microembolization during endovascular and conventional aneurysm repair.
OBJECTIVE
Endovascular aneurysm repair has been advocated as a "minimally invasive" alternative to conventional aneurysm surgery. However, because of manipulation within the aneurysm sac, endovascular techniques may result in massive microembolization.


METHODS
In this study lower limb microemboli were quantified in 29 patients undergoing conventional (11 straight and 7 bifurcated grafts) and endovascular aneurysm repair (8 aortoiliac, 1 straight, and 2 bifurcated grafts) by insonation of the superficial femoral artery with a 2 MHz Doppler probe. Emboli were detected as high-intensity, short-duration signals on the background Doppler trace. Differentiation of gaseous emboli from particulate emboli was achieved by calculation of the sample volume length (emboli velocity x duration = sample volume length) for each embolus (N = 4927). Previous experiments had determined that a sample volume length < 1.4 cm represented particulate embolization.


RESULTS
The number of gaseous, particulate, and total emboli were significantly greater in the endovascular group compared with the conventional group (p < 0.05).


CONCLUSIONS
These data demonstrate that peripheral microembolization is significantly higher during endovascular aneurysm repair than during conventional surgery. Methods to reduce embolization must be developed before endovascular aortic surgery is widely adopted.
Thompson
M M
MM
Department of Surgery, University of Leicester, United Kingdom.
Smith
J
J
Naylor
A R
AR
Nasim
A
A
Sayers
R D
RD
Boyle
J R
JR
Thompson
J
J
Tinkler
K
K
Evans
D
D
Smith
G
G
Bell
P R
PR
D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D018608:Ultrasonography, Doppler