A PROSPECTIVE RANDOMIZED STUDY COMPARING EXCLUSION TECHNIQUE AND ENDOANEURYSMORRHAPHY FOR TREATMENT OF INFRARENAL AORTIC-ANEURYSM

Purpose: The retroperitoneal approach used in aortic replacement for i nfrarenal aortic aneurysm has become an important part of the vascular surgeon's armamentarium. Use of the exclusion and bypass technique, h owever, remains controversial. Although benefits may include reduced b lood loss, less operative dissection, and a smoother intraoperative an d postoperative course, critics of this technique have alluded to pote ntial drawbacks. In this study the results of the exclusion technique and open endoaneurysmorrhaphy for surgical treatment of abdominal aort ic aneurysm were compared. Methods: One hundred patients were randomiz ed to either exclusion (EXC) or open endoaneurysmorrhaphy (OF) procedu res. A posterolateral left retroperitoneal approach was used in all pa tients. During surgery, autotransfusion devices were used when needed. Doppler flow and pressures in the excluded aneurysm sac were determin ed during surgery in EXC to evaluate the completeness of the exclusion . Results: Patient demographics were similar between the two groups. T he mean age was 70 years (range, 53 to 89 years). The operative mortal ity rates were 0% and 1.9% (1 of 51) in the EXC and OP groups, respect ively. Nonfatal postoperative complications occurred in 10.2% (5 of 49 ) of the EXC group and in 23.5% (12 of 51) of the OP group (p < 0.05). Aneurysm sacs were opened in two EXC procedures. Blood loss (mean +/- SD) was 703 +/- 570 ml in the EXC group and 1031 +/- 703 mi in the OP group (p less than or equal to 0.01). The intensive care unit stay (m ean +/- SD) was 1.9 +/- 1.2 days in the EXC group and 3.2 +/- 6.9 days in the OP group (p = NS). The hospital stay (mean +/- SD) was 9.8 +/- 5.8 days and 12.1 +/- 17 days in the EXC and OP groups, respectively (p = NS). There has been persistent flow in the excluded sac in two pa tients, with sac enlargement in one of these patients on postoperative follow-up by duplex scan or clinical examination. Conclusion: The exc lusion and bypass technique for repair of infrarenal aortic aneurysm a ppeared to be an acceptable technique and was associated with less ope rative blood loss and fewer postoperative complications than those of open aortic endoruleurysmorrhaphy. Exclusion bypass may contribute to a smoother perioperative course and postoperative treatment of these p atients.