Endovascular stent-graft repair of abdominal aortic aneurysms - single-centre experience and acute outcome

Introduction. Minimally invasive management of abdominal aortic aneurysms (AAA) by endovascular stent-grafting provides an alternative to conventional surgery in selected patients. Study objective, The aims of the study were to assess the efficacy of elective endoluminal exclusion of AAA in high-risk patients by insertion of a self-expanding, modular, bifurcated endovascular stent-graft system (AneuRx), Design. Open, controlled, prospective study. Patients who underwent conventional repair served as controls and reflected the current standard of care. Setting, Panorama Medi-Clinic, Parow, South Africa. Participants. Adult patients presenting with AAA fulfilling the inclusion criteria for endovascular repair (EVR), Interventions. Of 29 patients referred for minimally invasive surgery, 12 (41%) underwent consecutive EVR for AAA, The stent device was inserted by means of a two-stage delivery system via a 21F sheath introduced through bilateral common femoral artery arteriotomies and advanced under fluoroscopic guidance. 10 patients who underwent conventional surgery provided comparison with regard to hospital stay, blood transfusion and ventilation requirements and anaesthesia needs. Co-morbidities. The EVR and conventional surgery groups were similar with regard to co-morbidities. All but 1 patient had a high-risk factor of some sort. Results, 12 stent-grafts were successfully deployed in 12 recipients. Complete intraprocedural exclusion of the aneurysm (isolation of the AAA by EVR from the circulatory system) was achieved in 91.6%. The primary patency rate was 100% at 30 days. In no case was conversion to an open operation or concurrent open vascular procedure deemed necessary. 9 minor complications and 2 technical problems were recorded. The peri-operative and 30-day mortality rate was zero, Conclusion. Compared with traditional surgery, EVR of AAA offers considerable benefits as regards reduced peri-operative pain, avoidance of laparotomy, reduced blood transfusion requirements, rapid ambulation and early hospital discharge in high-risk patients, including octogenarians, provided patients are carefully selected.