Retrospective analysis of short-term and mid-term results of percutaneous endovascular repair in patients with abdominal aortic aneurysm

Česká verzia

Authors: M. Tóth ¹; J. Maďarič ¹; T. Balázs ²; J. Mikuláš ²; D. Hladíková ¹; R. Bažík ²; E. Drangová ²; T. Urlandová ¹; A. Klepanec ²; I. Vulev ²
Authors place of work: Oddelenie kardiológie a angiológie, Kardiologická klinika NÚSCH, a. s., Bratislava primár: MUDr. J. Maďarič, PhD., MPH. ¹; Oddelenie diagnostickej a intervenčnej rádiológie, NÚSCH, a. s., Bratislava primár: MUDr. I. Vulev, PhD., MPH. ²
Published in the journal: Rozhl. Chir., 2013, roč. 92, č. 12, s. 715-721.
Category: Original articles

Summary

Introduction:
Endovascular abdominal aortic aneurysm repair (EVAR) is a modern and, compared to conventional open surgery, less invasive therapeutic strategy with short-term lower morbidity and mortality. The aim of our retrospective analysis was the assessment of safety, technical success, short-term and mid-term results of elective patients scheduled for total percutaneous EVAR implantation (PEVAR).

Material and methods:
One hundred and sixteen consecutive patients (M:F 104:12, age 71±9 years, maximum AAA diameter 60±14mm) underwent elective PEVAR between January 2009 and August 2012. All the patients were treated under local anaesthesia by total percutaneous approach via femoral access. The immediate technical success of stentgraft implantation as well as the presence of 30-day and 1-year complications and the need of reintervention rate were assessed.

Results:
In 115/116 patients (99.1%),immediate technical success of the procedure was recorded, with no need of conversion to open surgery; in 1 patient (0.9%) the performance technically failed due to unfavourable arterial anatomy. The mortality in 30–day follow-up was 2.6% (3 patients), during 1-year follow-up it amounted to 8.6% (10 patients), without causal relationship with stentgraft implantation. Overall event-free survival was 85% (98/116) without serious complications (mortality, MI, stroke, reintervention, severe ischemic complication) in the one-year follow-up period.

Conclusion:
Endovascular AAA repair is a safe and feasible method with low mortality and acceptable complication rate in patients scheduled for EVAR implantation. Percutaneous approach allows for the extension of indications also for the highest-risk group of polymorbid patients. Technical feasibility and adequate periprocedural management are essential for further reduction in adverse events after PEVAR.

Key words:
abdominal aortic aneurysm – endovascular treatment – stentgraft – percutaneous approach

Zdroje

1. Thomson MM. Controlling the expansion of abdominal aortic aneurysms. Br J Surg 2003;90:897–898.

2. Scott RA, Asthon HA, Kay DN. Abdominal aortic aneurysm in 4237 screened patients: prevalence, development and management over 6 years. Br J Surg 1991;78:1122–1125.

3. Ashon HA, Buxton MJ, Day NE, et al. The Multicentre Aneurysm Screening Study (MASS) into effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet 2002;360: 1531–1539.

4. Berridge DC, Chamberlain J, Guy AJ, et al. Prospective audit of abdominal aortic aneurysm surgery in the northern region from 1988 to 1992. Northern Vascular Surgeons Group. Br J Surg 1995;82:906–910.

5. Brady AR, Fowkes FG, Greemhalgh RM, et al. Risk factors for postoperative deaths following elective surgical repair of abdominal aortic aneurysm: results from UK Small Aneurysm Trial. Br J Surg 2000;87:742–749.

6. Darling Rc, Cordero JA, Chang BB, et al. Advanced in the surgical repair of ruptured abdominal aortic aneurysms. Cardiovasc Surg 1996;4:720–723.

7. Feinglass J, Couper D, Dunlop D, et al. Late survival risk factors for abdominal aortic aneurysm repair: experience from fourteen Department of Veterans Affair hospitals. Surgery 1995;118: 16–24.

8. Choksy S, Wilmink A, Quick C. Ruptured abdominal aortic aneurysms in Huntingdon district: a 10 – year experience. Br J Surg 1997;84(Suppl 1):44.

9. Vařejka P, Linhart A. www.sanguis.cz/articles/files/62_Aneurysma_brisni_aorty.pdf

10. Köcher M, Utíkal P. Endovaskulární léčba aneuryzmat břišní aorty. In: Krajina A, Peregrín JH: Intervenční radiologie. Olga Čermáková, Hradec Králové 2005:281–294.

11. Kniemeyer HW, Kessler T, Reber PV, et al. Treatment of ruptured abdominal aortic aneurysm, a permanent challenge or a waste of resources? Prediction of outcome using a multiple – organ – dysfunction score. Eur J Vasc Endovasc Surg 2000:190–196.

12. Brown LC, Powel JT. Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. UK Small Aneurysm Trial Participants. Ann Surg 1999;230:289–296

13. Parodi JC, Barone A, Piraino R, et al. Endovascular treatment of abdominal aortic aneurysms: Lessons learned. J Endovasc Surg 1997;4:102–110.

14. Allen RC, Zarins CK, Fogarty TJ. The Medtronic – AneuRx medular bifurcated graft. In Yao JST, Pearce WH, eds. Techniques in Vascular and Endovascular Surgery. Stamford, Conticut, Appleton and Lange 1998:401–409.

15. van Marrewijk C, Buth J, Harris PL, et al. Significance of endoleaks after endovascular repair of abdominal aortic aneurysms: The EUROSTAR experience. J Vasc Surg 2002;35:461–473.

16. Patrono C, Bachmann F, Baigent C, et al. Antiplatelet agents - Expert Consensus Document on the Use of Antiplatelets Agent. European Heart Journal 2004;25:166–181.

17. Madaric J, Mistrik A, Vulev I, et al. The recurrence of iatrogenic femoral artery pseudoaneurysm afterocclusion by ultrasound guided percutaneous thrombin injection. Eurointervention 2009;5: 443–447.

18. Storck M, Scharrer–Pamler R, Kapfer X, et al. Does a postimplantation syndrome following endovascular treatment of aortic aneurysm exist? Vasc Surg 2001;35:23–29.

19. Zimmer S, Heiss MM, Schardey HM, et al. Inflammatory syndrome after endovascular implantation of an aortic stent – a comparative study. Langenbecks Arch Chir Suppl Kongessbd 1998;115:13–17.

20. Burger T, Heucke A, Halloul Z, et al. Interleukin pattern, procalcitonin level and cellular immune status after endovascular aneurysm surgery. Zentralbl Chir 2000;125:15–21.

21. Boyle JR, Goodall S, Thompson JP, et al. Endovascular AAA repair attenuates the inflammatory and renal responses associated with coventional surgery. J Endovasc Ther 2000;7:359–371.

22. Velázquez OC, Carpenter JP, Baum RA, et al. Perigraft air, fever, and leukocytosis after endovascular repair of abdominal aortic aneurysms. Am J Surg 1999;178:185–189.

23. Gabriel EA, Locali RF, Romano CC, et al. Analysis of the inflammatory response in endovascular treatment of aortic aneurysms. Eur J Cardiothorac Surg 2007;31:406–413.

24. Konstantinos G, Moulakakis MD, et al. The impact of endograft type on inflammatory response after endovascular treatment of abdominal aortic aneurysm. J Vasc Surg 2013;668–677.

25. Arnaoutoglou E, Kouvelos G, Milionis H, et al. Post – implantation syndrome following endovascular abdominal aortic aneurysm repair: preliminary data. Interact Cardiovasc Thorac Surg 2011;12:609–614.

26. Schermehorn M, OęMalley A, Jhaveri A, et al. Endovascular versus open repair of abdominal aortic aneurysms in the medicare population. N Engl J Med 2008;358:464–474.

27. Zarins CK, White RA, Schwarten DE, et al. AneuRx stent graft versus open surgical repair of abdomainal aortic aneurysms: multicenter prospective clinical trial. J Vasc Surg 1999;29:292–305.

28. Matsuramura JS, Bremster DC, Makaroun MS, et al. A multicenter controlled clinical trial of open verus endovascular treatment of abdominal aortic aneurysm. J Vasc Surg 2003;37:262–271.

29. Giles KA, Pomposseli F, Hamdan A, et al. Decrease in total aneurysm – related deaths in the era of endovasculart aneurysm repair. J Vasc Surg 2009;49:543–550.

30. Rocke TW, Hirsch AT, Misra S, et al. Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society for Vascular Medicine; Society for Vascular Surgery. 2011 ACCC/AHA Focused Update of the Guideline for the management of Patients With Peripheral Arthery Disease (updating the 2005 guideline): a report of the Americane College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2011;58:2020–2045.

31. Greenhalgh RM, Brown LC, Powell JT, et al. Endovascular versus open repair of abdominal aortic aneurysm. N Eng J Med 2010;362:1863–1871.

32. De Bruin JL, Baas AF, Buth J, et al. Long – term outcome of open or endovascular repair of abdominal aortic aneurysm. N Eng J Med 2010;362:1881–1889.

33. Greenhalgh RM, Brown LC, Kwong GP, et al. EVAR trial participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30 – days operative mortality results: Randomised controlled trial. Lancet 2004;364:843–848.

34. Becquemin JP, Allaire E, Desgranges P, et al. Delayed complications following EVAR. Tech Vasc Interv Radiol 2005;8:30–40.