MICROEMBOLIZATION DURING ENDOVASCULAR AND CONVENTIONAL ANEURYSM REPAIR

Purpose: Endovascular aneurysm repair has been advocated as a ''minima lly invasive'' alternative to conventional aneurysm surgery. However, because of manipulation within the aneurysm sac, endovascular techniqu es may result in massive microembolization. Methods: In this study low er limb microemboli were quantified in 29 patients undergoing conventi onal (11 straight and 7 bifurcated grafts) and endovascular aneurysm r epair (8 aortoiliac, 1 straight, and 2 bifurcated grafts) by insonatio n of the superficial femoral artery with a 2 MHz Doppler probe. Emboli were detected as high-intensity, short-duration signals on the backgr ound Doppler trace. Differentiation of gaseous emboli from particulate emboli was achieved by calculation of the sample volume length (embol i velocityxduration=sample volume length) for each embolus (N=4927). P revious experiments had determined that a sample volume length <1.4 cm represented particulate embolization. Results: The number of gaseous, particulate, and total emboli were significantly greater in the endov ascular group compared with the conventional group (P <0.05). Conclusi ons: These data demonstrate that peripheral microembolization is signi ficantly higher during endovascular aneurysm repair than during conven tional surgery. Methods to reduce embolization must be developed befor e endovascular aortic surgery is widely adopted.