[Investigation of endovascular aneurysm repair of complex abdominal aortic aneurysm in high-risk patients].
OBJECTIVE
To evaluate the results of a variety of alternative endovascular techniques applied to patients with complicated abdominal aortic aneurysm complex abdominal aortic aneurysm (cAAA) and unsuitable for open surgery.


METHODS
From January 2001 to December 2010, charts of all patients having an abdominal aortic aneurysm (AAA) were reviewed. Endovascular aneurysm repair (EVAR) was done in 138 patients, in which 9 patients were defined as cAAA such as juxta-renal AAA, short or angulated AAA neck, AAA with bilateral iliac artery aneurysms. There were 8 male and 1 female patients, aged from 26 to 87 years with a mean of 67 years. All these patients at high risk for open surgery were offered a modified EVAR technique including fenestrated technique, scallop technique, chimney technique, balloon assisted U-turn stenting and reverse-U stent-graft in 2, 5, 1 and 1 patients respectively.


RESULTS
All techniques were successful and without severe postoperative complications. An intraoperative endoleak was found in 4 patients and was corrected immediately. One patient with type I and III endoleaks underwent dilatation with a compliant balloon. Two patients with type I endoleak underwent coil embolization (1 patient) and bare stent (1 patient). During follow-up, one patient with a type II endoleak who demonstrated no increase in sac diameter during follow-up was observed. Mean follow-up was 25.9 months (ranging from 4 to 79 months). No rupture occurred and 8 aneurysms shrink significantly. In 7 patients, critical vessels (renal and mesenteric arteries) were protected during the initial procedure and remained patent except in one patient who was performed reverse "U" stent graft with thrombosis in hypogastric artery.


CONCLUSIONS
High-risk patients with cAAA inappropriate for traditional EVAR can be successfully treated by using simple ancillary endovascular techniques with acceptable short or mid-term results.
Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing 100730, China.
Bao
B
Liu
Chang-wei
CW
Liu
Yue-hong
YH
Zheng
Yong-Jun
YJ
Li
Ji-dong
JD
Wu
Wei-wei
WW
Wu
Wei
W
Ye
Xiao-jun
XJ
Song
Rong
R
Zeng
Yue-xin
YX
Chen
Jiang
J
Shao
Yu
Y
Chen
Leng
L
Ni
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome