Endovascular aneurysm repair in high-risk patients.
OBJECTIVE
The purpose of this study was to evaluate the role of endovascular aneurysm repair in high-risk patients.


METHODS
The elective endovascular repair of infrarenal aortic aneurysm was performed in 116 high-risk patients with either custom-made or commercial stent grafts. The routine follow-up examination included contrast-enhanced computed tomography (CT) before discharge, at 3, 6, and 12 months, and annually thereafter. Patients with endoleak on the initial CT underwent re-evaluation at 2 weeks. Those patients with positive CT results at 2 weeks underwent endovascular treatment.


RESULTS
Endovascular repair was considered feasible in 67% of the patients. The mean age was 75 years, and the mean aneurysm diameter was 6.3 cm. The American Society of Anesthesiologists grade was II in 3.4%, III in 65.5%, IV in 30.1%, and V in 0.9%. There were no conversions to open repair. Custom-made aortomonoiliac stent grafts were implanted in 77.6% of the cases, custom-made aortoaotic stent grafts in 11.2%, and commercial bifurcated stent grafts in 11.2%. The 30-day rates of mortality, major morbidity, and minor morbidity were 3.4%, 20.7%, and 12%, respectively, in the first 58 patients and 0%, 3.4%, and 3.4%, respectively, in the last 58. The late complications included five cases of stent graft kinking, two cases of femorofemoral graft occlusion, and three cases of proximal stent migration, one of which led to aneurysm rupture. At 2 weeks after repair, endoleak was present in 10.3% of the cases. All the type I (direct perigraft) endoleaks underwent successful endovascular treatment, whereas only one type II (collateral) endoleak responded to treatment. The technical success rate at 2 weeks was 86.2%, and the clinical success rate was 96.6%. The continuing success rate was 87.9%. Seventeen patients died late, unrelated deaths.


CONCLUSIONS
Endovascular aneurysm repair is safe and effective in patients at high risk, for whom it may be the preferred method of treatment.
Chuter
T A
TA
Divisions of Vascular Surgery, University of California-San Francisco, CA 94143, USA.
Reilly
L M
LM
Faruqi
R M
RM
Kerlan
R B
RB
Sawhney
R
R
Canto
C J
CJ
LaBerge
J M
JM
Wilson
M W
MW
Gordon
R L
RL
Wall
S D
SD
Rapp
J
J
Messina
L M
LM
D000368:Aged; D000792:Angiography; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods* / Q000401:mortality; D017544:Aortic Aneurysm, Abdominal / Q000145:classification / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D015897:Comorbidity; D005500:Follow-Up Studies; D006801:Humans; D018579:Patient Selection; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects; D016019:Survival Analysis; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome