Download PDF
Thorac Cardiovasc Surg 2005; 53(5): 291-294
DOI: 10.1055/s-2005-837680
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Endovascular vs. Open Surgery of Abdominal Aortic Aneurysm in High-Risk Patients: A Single Center Experience[1]

G. Iannelli1 , M. Monaco1 , L. Di Tommaso1 , F. Piscione2 , P. Stassano1 , P. P. Mainenti3 , S. Laurino4 , N. Spampinato1
  • 1Department of Cardiac Surgery, University of Naples “Federico II”, Naples, Italy
  • 2Department of Cardiology, University of Naples “Federico II”, Naples, Italy
  • 3Department of Radiology, University of Naples “Federico II” Naples, Italy
  • 4Department of Anaesthesiology, University of Naples “Federico II” Naples, Italy
Further Information

Publication History

Received December 15, 2004

Publication Date:
06 October 2005 (online)

    Permissions and Reprints All articles of this category

Abstract

Background: We compared two groups of high-risk patients with abdominal aortic aneurysm to assess the safety and efficacy of endovascular repair vs. open surgery. Methods: From January 1998 to July 2003, sixty-two high-risk patients were divided into two groups: group A consisted of 28 (46 %) open surgery patients and group B consisted of 34 (54 %) patients who underwent endovascular repair. Results: Four patients (14.3 %) in the open surgery group died, while no deaths occurred in the endovascular group (p < 0.05). There were 14 complications in 8 patients of the open surgery group versus 2 complications in 2 patients of the endovascular group (p = 0.01). At follow-up there were 4 (16.6 %) deaths in group A and 3 (8.8 %) in the endovascular group (p = n. s.). Conclusions: While the use of endovascular repair in patients who are physiologically fit for open surgical repair remains controversial, we believe that patients with multiple or advanced comorbidities, i.e. high-risk patients, can benefit from the endografting procedure.

Key words

Abdominal aortic aneurysm - endovascular aortic repair - open aortic surgery

1 Presented at the 10th Annual Cardiothoracic Technique - 13, 2004 Miami, FL, USA

References

  • 1 Dardik A LJW, Gordon T A, Williams G M. et al . Results of elective abdominal aortic aneurysm repair in the 1990s. A population-based analysis of 2335 cases.  J Vasc Surg. 1999;  30 985-995
    CrossrefPubMedGoogle Scholar
  • 2 Jordan W D, Alcocer F, Wirthlin D J, Westfall A O, Whitley D. Abdominal aortic aneurysms in high-risk surgical patients. Comparison of open and endovascular repair.  Ann Surg. 2003;  237 623-630
    CrossrefPubMedGoogle Scholar
  • 3 Hallett Jr J W. Management of abdominal aortic aneurysm.  Mayo Clin Proc. 2000;  75 395-399
    PubMedGoogle Scholar
  • 4 Johnson K W. Multicenter prospective study of nonruptured abdominal aortic aneurysm. Variables predicting morbidity and mortality.  J Vasc Surg. 1989;  9 437-447
    CrossrefPubMedGoogle Scholar
  • 5 Parodi J C, Palmaz J C, Barone H D. Transfemoral intraluminal graft implantation for abdominal aortic aneurysm.  Ann Vasc Surg. 1991;  5 491-499
    CrossrefPubMedGoogle Scholar
  • 6 Iannelli G, Piscione F, Di Tommaso L. et al . Thoracic aortic emergencies: impact of endovascular surgery.  Ann Thorac Surg. 2004;  77 591-596
    CrossrefPubMedGoogle Scholar
  • 7 Hallett Jr J W, Naesens J M, Ballard D J. Early and late outcomes of surgical repair for small abdominal aortic aneurysm. A population-based analysis.  J Vasc Surg. 1993;  18 684-691
    PubMedGoogle Scholar
  • 8 Demers P, Miller D C, Mitchell R S. et al . Midterm results of endovascular repair of descending thoracic aortic aneurysms with first-generation stent grafts.  J Thorac Cardiovasc Surg. 2004;  127 664-673
    CrossrefPubMedGoogle Scholar
  • 9 Chaikof E L, Blankesteijn J D, Harris P L. et al . Reporting standards for endovascular aortic aneurysm repair.  J Vasc Surg. 2002;  35 1048-1060
    CrossrefPubMedGoogle Scholar
  • 10 White G H, Yu W, May J. Endoleak: a proposed new terminology to describe incomplete aneurysm exclusion by an endoluminal graft.  J Endovasc Surg. 1996;  3 124-125
    PubMedGoogle Scholar
  • 11 Kazmers A, Jacobs L, Perkins A. et al . Abdominal aortic aneurysm repair in Veterans Affairs Medical Center.  J Vasc Surg. 1996;  23 191-200
    PubMedGoogle Scholar
  • 12 Johnson K W. Canadian Society for Vascular Surgery Aneurysm Study Group . Nonruptured abdominal aortic aneurysm.  J Vasc Surg. 1994;  20 163-170
    PubMedGoogle Scholar
  • 13 Ashley S, Riddler B. The Vascular Surgical Society of Great Britain and Ireland .National Vascular Database Report, 2002. Oxfordshire, GB; Dendrite Clinical Systems Ltd. 2002
    Google Scholar
  • 14 Conners III M S, Sternbergh III W C, Carter G. et al . Endograft migration one to four years after endovascular abdominal aortic aneurysm repair with the AneuRx device: A cautionary note.  J Vasc Surg. 2002;  36 476-484
    CrossrefPubMedGoogle Scholar
  • 15 Collin J, Murie J A. Endovascular treatment of abdominal aortic aneurysm: a failed experiment.  Br J Surg. 2001;  88 1281-1282
    CrossrefPubMedGoogle Scholar
  • 16 Allaqaband S, Mortada M E, Tumuluri R. et al . Endovascular stent graft repair of abdominal aortic aneurysms in high-risk patients: A single center experience.  J Interv Cardiol. 2004;  17 71-79
    CrossrefPubMedGoogle Scholar
  • 17 Brown L C, Epstein D, Manca A. et al . The UK Endovascular Aneurysm Repair (EVAR) trials: design, methodology and progress.  Eur J Vasc Endovasc Surg. 2004;  27 372-381
    PubMedGoogle Scholar
  • 18 Laheij R JF, van Marrewijk C J. on behalf of the Eurostar group . Endovascular stenting of abdominal aortic aneurysm in patients unfit for elective open surgery. European Collaborators Registry on stent-graft techniques for abdominal aortic aneurysm repair.  Lancet. 2000;  356 832
    CrossrefPubMedGoogle Scholar

1 Presented at the 10th Annual Cardiothoracic Technique - 13, 2004 Miami, FL, USA

MD Gabriele Iannelli

c/o Villa del Sole

Via Manzoni, 15

80123 Napoli

Italy

Email: gabrieleiannelli@libero.it