EARLY EXPERIENCE WITH THE SYDNEY AND EVT PROSTHESES FOR ENDOLUMINAL TREATMENT OF ABDOMINAL AORTIC-ANEURYSMS

Purpose: The aim of this study was to report early experiences with th e Sydney and Endovascular Technologies (EVT) prostheses for the treatm ent of abdominal aortic aneurysms (AAA) deemed suitable for endolumina l tube graft repair. Methods: Consecutive endoluminal tube graft repai rs were analyzed over the first 12 months in which the Sydney and EVT prostheses were used. Patients eligible for the EVT prosthesis had typ e I AAAs: a proximal neck length greater than or equal to 2 cm, a dist al cuff length greater than or equal to 1.5 cm, and nontortuous iliac arteries greater than or equal to 8 mm. Selection criteria for the Syd ney device were more liberal and included AAAs that had distal cuffs < 1.5 cm. During the study period, 28 of 91 patients evaluated for AAA repair were thus selected for endoluminal grafting: 18 patients receiv ed the Sydney endograft and 10 the EVT device. Medical comorbidities w ere present in slightly less than one third of patients in both groups . Contrast-enhanced computerized tomography (CT) was performed preoper atively, within 10 days of operation, and at 6 and 12 months postproce dure. Results: All endografts were successfully deployed in both group s. Postprocedural CT scans revealed incomplete aneurysm exclusion in f our patients with the Sydney endograft. Subsequent deployment of a sec ond endograft sealed these ''leaks'' in two cases; the other two were converted to open repair (89% clinical success). No leaks were seen wi th the EVT device. Local/vascular complications occurred in 33% of the Sydney group compared with 20% for the EVT device (p = 0.001); system ic sequelae were more common in the EVT group (30% versus 17% in the S ydney cohort, p = 0.002). There were no deaths within 30 days; three l ate deaths were not procedure related. Conclusion: AAAs that are suita ble for endoluminal tube graft repair may be treated with a high rate of initial success with either the Sydney or EVT prostheses. More libe ral selection criteria may increase the likelihood of local/vascular c omplications.