Endovascular treatment of abdominal aortic aneurysms in high-surgical-risk patients using commercially available stent-grafts.
OBJECTIVE
To analyze the initial and long-term results of endovascular aneurysm repair (EVAR) in high-surgical-risk patients (i.e., age > or =80 years, serum creatinine level > or =3 mg/dL, severe pulmonary dysfunction, severe cardiac dysfunction).


METHODS
From April 2002 to June 2009, 50 consecutive high-surgical-risk patients (42 men; mean age 74.0+/-8.7, range 54-91) with an abdominal aortic aneurysm (AAA; mean diameter 64.8 mm) who were treated electively using a bifurcated aortic endograft (32 Excluder, 18 Zenith) were entered in a prospective registry. Thirty-five (70%) patients were classified ASA III and 15 (30%) were ASA IV. High-risk status was corroborated using the Customized Probability Index (CPI). Primary endpoints were operative mortality and long-term survival; secondary endpoints were the frequency of reintervention, evolution of the aneurysm sac, and rates of primary and secondary patency and rupture.


RESULTS
The mean CPI score was 11.04+/-6.3. Operative mortality was 2% (1/50). There were 4 endoleaks, 1 case of endotension, and 1 endograft limb occlusion. Two patients required reintervention during the mean follow-up of 35.6 months. Survival at 3 years was 94%. Primary and secondary patency rates at 3 years were 98% and 100%, respectively. There were no ruptures.


CONCLUSIONS
Initial and long-term results with endovascular treatment of AAA in high-surgical-risk patients were satisfactory and appear to justify this approach in this patient population.
Mendonça
Célio Teixeira
CT
Department of Vascular and Endovascular Surgery, Universidade Positivo, Curitiba, Paraná, Brazil. celiotm@brturbo.com.br
de Carvalho
Cláudio Augusto
CA
Weingärtner
Janaína
J
Shiomi
Alexandre Yoshiharu
AY
de Melo Costa
Daniel Simões
DS
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D003404:Creatinine / Q000097:blood; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000097:blood / Q000150:complications; D008171:Lung Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012042:Registries; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D003404:Creatinine