[Endovascular treatment of the abdominal aortic aneurysm: assessment, implantation technique, after-care and results].

BACKGROUND

Endovascular treatment of abdominal aortic aneurysm (AAA) is a new minimally invasive alternative to surgical repair. Patient selection, perioperative management, the procedure itself and postoperative follow-up are new aspects.

PATIENTS: From June 1997 to June 1998, 37/70 patients (53%) with AAA were treated by the endovascular method. There were 35 males and two females, mean age 74 +/- 7 years, with a mean ASA class of 3.5 +/- 0.5. Graft repair was performed in 33 patients, due to inappropriate aortic anatomy for the endovascular technique in 24 and leaking aneurysm in 9.

METHODS

Feasibility is based upon computed tomography and angiography. The procedure was performed in the operating room, under general, regional and local anaesthesia in 14, 3 and 20 patients, respectively. 36 bifurcated and one tube endoprosthesis were implanted. An open access on one femoral or iliac artery and, in case of bifurcated prosthesis, usually a percutaneous access (10 Fr) on the other side were performed. Positioning and delivery were monitored under fluoroscopy.

RESULTS

All the AAA could be sealed by the endovascular technique. In one patient, an iliac limb was removed surgically because of proximal misplacement, but the procedure was completed by the endovascular technique. Mean operation time was 140 +/- 67 minutes. ICU stay was 1.4 +/- 1.6 days and patients were discharged after 6.5 +/- 3.5 days. Postoperative radiological follow-up showed totally sealed aneurysms in 34/37 patients (91%). In 3 patients a residual perfusion originating from a lumbar artery was observed. In 7/14 patients with AAA diameter > 6 cm and without residual leakage on the control CT scan, aneurysm pulsation remained after endovascular treatment. There was no early or late death after endovascular repair. During the follow-up period of 4 +/- 3 months patients are doing well. One patient needed balloon dilatation of an iliac limb.

CONCLUSIONS

Endovascular treatment of AAA is a minimally invasive technique with short recovery time. This technique seems to be particularly advantageous in elderly or severely ill patients. Long-term controls are mandatory to identify potential complications, particularly when residual perfusion or aneurysm pulsation persists.