Short-Term Outcome of Endovascular Repair of Aortic Aneurysms with Stent Grafts: Initial Results of the First Consecutive Series of Endovascular Aortic Repair in Iran.

Document Type : Original Article

Authors

Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background- Endovascular aortic repair (EVAR), as a new and less invasive method for treatment of
aortic aneurysms, has shown lower short term complications than routine open surgical repairs. In
this report we present our results with the first consecutive series of this technique in our patients.
Methods- From Dec. 2006, we began a prospective case series of EVAR patients for the first time in
Iran, and so far, 15 consecutive patients (1 female, 14 male) with the mean age of 66 years (range
36 to 89 years old) underwent endovascular aortic aneurysm repair (3 thoracic, 11 abdominal, 1
combined thoracic and abdominal) with Medtronic “Talent” or “Valiant” stent grafts. In-hospital
and one month follow up results are reported as short-term outcome.
Results- All 12 abdominal aorta aneurysms (AAA) were infrarenal with an acceptable proximal neck. In
eight patients, associated iliac aneurysms were seen. For 11 AAA patients, routine modular stent
grafts were used and in one case, unilateral stent graft was implanted because of difficulty of
controlateral stent graft implantation. Four thoracic aorta aneurysms (TAA) were repaired with
Valiant stent grafts. One of them was a Marfan patient with recent Bentall surgery and two were
post-surgery saccular aneurysms. In all 15 cases, stent graft implantation was done successfully. In
five cases, mild type II endoleak was seen at the end of the procedure, which was no longer
present on one month follow up. One patient had post- procedure cerebral stroke with delayed
mortality. No other major complications were seen in 1 month follow up in the other 14 cases.
Minor complications like vascular access hematoma, anemia and increased creatinine were
controlled on hospital stay period in some cases. Control CT angiography in some patients
revealed no endoleak or aneurysm enlargement and 6 and 12-month follow up assessment will be
done for mid-term results.
Conclusion- Endovascular repair of aortic aneurysm is feasible and safe for suitable cases based on both
clinical and radiologic findings. Good case selection, good device selection and suitable follow up
are the keys for success of EVAR (Iranian Heart Journal 2008; 9 (1): 6-13).

Keywords

References

1. Parodi JC, Palmaz JC, Barome HD. Transfemoral
intraluminal graft implantation for abdominal
aortic aneurysms. Ann Vasc Surg 1991; 5:
491-499.
2. Bickerstaff LK, Pairolero PC, Hollier LH, Melton
LJ, Vanpeenen HJ, Vherry KJ, et al. Thoracic
aortic aneurysms: A population-based study.
Surgery 1982; 92: 1103-1108.
3. Cardio FJ, Clark NS, Barnatan MF. Stent graft
repair in the aortic arch and descending
thoracic aorta: A 4-year experience. J Vasc
Surg 2002; 36: 1121-11287.
4. Coady MA, Rizzo JA, Goldstein LY, Elefteriades
JA. Natural history, pathogenesis and etiology
of thoracic aortic aneurysms and dissections.
Cardiol Clin 1999; 17: 615-635.
5. Clouse WD, Hallett JW, Jr. Schaff HV. Acute
aortic dissection: population based incidence
compared with degenerative aortic aneurysm
rupture. Mayo Clin Proc 2004; 79: 176-180.
6. Perko MJ, Norgard M, Herzog TM, et al.
Unoperated aortic aneurysm: A survey of 170
patients. Ann Thorac Surg 1995; 59: 1204-
1209.
7. Safi HJ, Estera AL, Miller CC. Evolution of risk
for neurologic deficit after descending and
thoracoabdominal aortic repair. Ann Thorac
Surg 2005; 80: 2173-2179.
8. Volodos ML, Karpovich IP, Troyan VI,
Kalashnikova YV, Shekhanin VG, Ternyak
NE. Clinical experience of the use of self-
fixating synthetic prosthesis for remote
endoprosthesis of the thoracic and abdominal
aorta and iliac arteries through the femoral
artery and as intraoperative endoprosthesis for
aortic reconstruction. Vasa 1991; 33: 93-95.
9. Dake MD, Miller DC, Semba CP, Mitchell RS,
Walker PJ, Liddell RP. Transluminal
placement of endovascular stent graft for the
treatment of descending thoracic aortic
aneurysm. N Engl J Med 1994; 331: 1729-
1734.
10. Pei Ho, Wai Ki yiu, Grace Chung. Systematic
review of clinical trials comparing open and
endovascular treatment of abdominal
aneurysm. Surgical Practice 2006; 10: 24-37.
11. The EVAR Trial 2 participants. Endovascular
aneurysm repair and outcome in patients unfit
for open repair of abdominal aortic aneurysm.
Lancet 2005; 2187-92.
12. Greenhalgh RM, Brown LC, Kwong GP.
Comparison of endovascular aneurysm repair
with open repair in patients with abdominal
aortic aneurysm (EVAR Trial 1): 30 day
operative mortality results: Randomized
controlled trial. Lancet 2004; 364: 843-848.
13. Prinssen M, Verhoven EL, Buth J . A randomized
trial comparing conventional and
endovascular repair of abdominal aortic
aneurysms. N Engl Med 2004; 351: 1607-
1618.
14. Leurs LJ, Bell R, Degrieck Y, Thomas S, Hobo
R, Lundboam J, on behalf of the EUROSTAR
and UK Thoracic Endograft Registry.
Endovascular treatment of thoracic aortic
disease: combined experience from the
EUROSTAR and UK Thoracic Endograft
Registry. J Vasc Surg 2004; 40: 670-679.
Iranian Heart Journal
Volume 9, Issue 1
March 2008
Pages 6-13

Files

Share

How to cite

Statistics