J. May et al., Adverse events after endoluminal repair of abdominal aortic aneurysms: A comparison during two successive periods of time, J VASC SURG, 29(1), 1999, pp. 32-37
Citations number
8
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Purpose: The aim of this study was to document the incidence rate of advers
e events after endoluminal repair of abdominal aortic aneurysms (AAAs) duri
ng two successive periods of time.
Methods: One hundred ninety patients (175 men, 15 women; mean age, 72 years
) underwent endoluminal repair of AAAs in a 5 1/2-year period. Adverse even
ts were documented prospectively for all the patients throughout this inter
val. An adverse event was defined as any of the following events: a death w
ithin 30 days, a conversion to open repair, the need for further interventi
on (either open or endovascular), the need for hemodialysis, a failure to c
ure the ABA, and wound complications. The patients were divided into two gr
oups-those who underwent operation in the initial 3-year period (group I; n
= 75) and those who underwent operation in the subsequent 2 1/2-year perio
d (group II; n = 115). The results were analyzed for total adverse events f
or both periods of time and for difference in incidence rates within catego
ries of adverse events between the two groups.
Results: Eight patients (4.2%) died in the perioperative period. The endolu
minal. repair failed in 17 patients (8.9%), which necessitated a primary co
nversion to open repair at the original operation. In gs patients, 110 adve
rse events occurred. There was no significant difference in the incidence r
ates of adverse events in patients in group I (37/75) and group II (51/115)
. Apart from primary conversion (P =.007), there was no significant differe
nce in the incidence rates of adverse events between group I and group II w
ithin the following categories: perioperative (within 30 days) deaths, prim
ary conversion, secondary conversion, supplementary endoluminal repair, int
ervention for lower Limb ischemia, hemodialysis necessitated, failure to cu
re the AAA as a result of persistent endoleak, and wound complications.
Conclusion: Despite improvements in technology and increasing experience, a
dverse events continue to occur in a relatively high proportion of patients
(45%) who undergo endoluminal repair of AAA. Reporting the incidence rates
of adverse events provides a more accurate picture of the morbidity rates
of the endoluminal method rather than simply listing the procedures as succ
esses or failures. The similarity in the incidence rates of adverse events
in patients in group I and group II suggests that there we inherent risks i
n the endoluminal method rather than iatrogenic complications that occur du
ring the learning curve with a new technique.