[New chapter of vascular surgery; stent-graft placement in the treatment of aortic aneurysm].
OBJECTIVE
This paper deals with a novel chapter of aneurysm surgery, the stent-graft implantation. The interdisciplinary cooperation between angio-radiology and surgery made available a much less invasive therapeutic option. The new technique was first applied in 1991.The authors present the technique, conditions and results of the procedure and also give a survey on the domestic situation.


METHODS
In general anaesthesia using inguinal approach a self-expanding stent-graft (diameter: 8 mm) equipped with barbs was inserted in the aorta and deployed into the aneurysm under X-ray guidance. Vanguard (Boston-Scientific Co.), Talent (Medtronic Co.) and Exluder (Gore-Tex Co.) instruments were used.


RESULTS
In 40 patients (29 men and 11 women, mean age: 59.7 years) 55 stent-grafts were implanted. Thirty-one thoracic and 9 infrarenal aneurysms were treated. In 3 patients ruptured aneurysm, in 3 other instances covered ruptured aneurysm, and in 3 persons symptomatic aortic aneurysm were treated. Thirty-one patients underwent elective procedures. Two deaths occurred in the early, and 4 in the late postoperative period (at months 3, 6, 7 and 36 postoperatively). In 9 patients adjunctive vascular surgery interventions were performed in 13 instances. Primary endoleak occurred in 3, whereas secondary endoleak was observed in 4 instances. All of these healed spontaneously. The authors compared the domestic results with internationally published data. This included 1120 traditional aneurysm resections and 110 stent-graft implantations performed in Hungary and 2283 surgical and 3843 endovascular procedures published in international scientific journals.


CONCLUSIONS
The indications for this new procedure are still being formed. Despite the higher incidence of complications, this less traumatic intervention can be applied with benefit for patients. Nevertheless, at the time being, financial considerations may prevent the more widespread use in the practice. In Hungary the conditions are already available for this endovascular treatment and the authors support its employment.
Nemes
Attila
A
Semmelweis Egyetem, Altalános Orvostudományi Kar, Er- es Szívsebészeti Klinika, Budapest.
Dzsinich
Csaba
C
Hüttl
Kálmán
K
Acsády
György
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D006814:Hungary; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D015607:Stents; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods*