[Aortic stent: the vascular surgeon's point of view].
Endovascular repair has been suggested as an attractive, revolutionary and less invasive technique for treating abdominal aorta aneurysms (AAA).The vascular surgeon plays a role in an interdisciplinary approach to treatment, given that several professionals are involved in the success of this new technique. Preoperative imaging techniques, patient screening, endoprosthetic selection, anesthetic management, endovascular skill and preoperative and postoperative monitoring are the elements that determine clinical and technical success. The surgeon must coordinate all members of the treatment team and assumes final responsibility for each of the sub-processes of the procedure. Our team's 3-year experience encompasses 110 AAA, 38 isolated aorta aneurysms and 8 isolated iliac aneurisms. It has been possible to implant stents without complications in 98.2% of the AAA cases. Perioperative mortality was 4.5% for AAA cases. Primary leaks were recorded in 14.8% of AAA, most of which were resolved through additional endovascular procedures. Migrations of 5.4% of the stents occurred, and branch dislocations were seen in 1.8% during follow-up. Hospital mortality was 1.8% for AAA. To date, no conversion has occurred, either immediately after surgery or during follow-up. In conclusion, an interdisciplinary approach provides the best formula for introducing and applying this new therapeutic technique. The vascular surgeon should coordinate the team and take final clinical responsibility. The long-term results show that endovascular repair of AAA deserves a place in our therapeutic arsenal.
Riambau
V
V
Instituto de Enfermedades Cardiovasculares, Hospital Clínic de Barcelona, Spain
D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D001027:Aortography; D004630:Emergencies; D005548:Foreign-Body Migration; D006801:Humans; D007430:Intraoperative Care; D008875:Middle Aged; D010348:Patient Care Team; D018579:Patient Selection; D011184:Postoperative Period; D011475:Prosthesis Failure; D015607:Stents / Q000009:adverse effects / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation* / Q000401:mortality