title: Endovascular strategy for the elective treatment of concomitant aortoiliac aneurysm and symptomatic large bowel diverticular disease.
abstract: BACKGROUND
  The purpose of this study was to evaluate the strategy for treatment of patients presenting with asymptomatic diverticular disease of the large bowel associated with an asymptomatic aortoiliac aneurysmal (AAA) disease.
  
  
  METHODS
  Sixty-nine patients were included in this retrospective study. The patients were divided into 5 groups according to the type and sequence of the surgical treatment: 32 patients (47%) underwent colectomy followed by a staged open AAA repair (group A); 10 patients (14%) were treated with open AAA repair followed by a staged colectomy (group B); 13 patients (18%) received endovascular aneurysm repair (EVAR) followed by a staged bowel resection (group C); 8 patients (12%) had a bowel resection followed by staged EVAR (group D); and 6 patients (9%) underwent simultaneous open AAA repair and bowel resection (group E). Primary end points were mortality and complications after any of the procedures. Secondary end point was the time interval between the staged procedures.
  
  
  RESULTS
  The cumulative death rate for delayed treatment of AAA was 6.5% and 0% for delayed treatment of diverticular disease [P=0.22]. The mean time interval between the staged procedures was 11 days for EVAR/colon resection (group C and group D) and 73 days for open AAA repair/colon resection (group A and group B; P<0.01).
  
  
  CONCLUSIONS
  EVAR allows a significant reduction in the time required between AAA repair and colon resection, but no definite rule can be established regarding the sequence of staged procedures. Combined procedures should be reserved for selected cases.
authors: Francesco Durante Department of Surgery, University of Rome La Sapienza, Rome, Italy. Electronic address: giulio.illuminati@uniroma1.it.
authors: Giulio
authors: G
authors: Illuminati
authors: Department of Vascular Surgery, University of Poitiers, Poitiers, France.
authors: Jean-Baptiste
authors: JB
authors: Ricco
authors: Department of Vascular Surgery, University of Poitiers, Poitiers, France.
authors: Fabrice
authors: F
authors: Schneider
authors: Francesco Durante Department of Surgery, University of Rome La Sapienza, Rome, Italy.
authors: Francesco G
authors: FG
authors: Caliò
authors: Francesco Durante Department of Surgery, University of Rome La Sapienza, Rome, Italy.
authors: Gianluca
authors: G
authors: Ceccanei
authors: Francesco Durante Department of Surgery, University of Rome La Sapienza, Rome, Italy.
authors: Maria A
authors: MA
authors: Pacilè
authors: Francesco Durante Department of Surgery, University of Rome La Sapienza, Rome, Italy.
authors: Giulia
authors: G
authors: Pizzardi
authors: Francesco Durante Department of Surgery, University of Rome La Sapienza, Rome, Italy.
authors: Piergaspare
authors: P
authors: Palumbo
authors: Francesco Durante Department of Surgery, University of Rome La Sapienza, Rome, Italy.
authors: Francesco
authors: F
authors: Vietri
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000592:standards; D003082:Colectomy / Q000379:methods* / Q000592:standards; D004241:Diverticulum, Colon / Q000150:complications / Q000601:surgery*; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000379:methods / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome