Endovascular treatment of abdominal aortic aneurysm: preoperative investigations, implantation technique, postoperative follow-up, and results

Background: Endovascular treatment of abdominal aortic aneurysm (AAA) is a new minimally invasive alternative to surgical repair. Patient selection, p erioperative management, the procedure itself and postoperative follow-up a re new aspects. Patients: From June 1997 to June 1998, 37/70 patients (53%) with AAA were t reated by the endovascular method. There were 35 males and two females, mea n age 74 +/- 7 years, with a mean ASA class of 3.5 +/- 0.5. Graft repair wa s performed in 33 patients, due to inappropriate aortic anatomy for the end ovascular technique in 24 and leaking aneurysm in 9. Methods: Feasibility is based upon computed tomography and angiography. The procedure was performed in the operating room, under general, regional and local anaesthesia in 14, 3 and 20 patients, respectively. 36 bifurcated an d one tube endoprosthesis were implanted. An open access on one femoral or iliac artery and, in case of bifurcated prosthesis, usually a percutaneous access (10 Fr) on the other side were performed. Positioning and delivery w ere monitored under fluoroscopy. Results: All the AAA could be sealed by the endovascular technique. In one patient, an iliac limb was removed surgically because of proximal misplacem ent, but the procedure was completed by the endovascular technique. Mean op eration time was 140 +/- 67 minutes. ICU stay was 1.4 +/- 1.6 days and pati ents were discharged after 6.5 +/- 3.5 days. Postoperative radiological fol low-up showed totally sealed aneurysms in 34/37 patients (91%). In 3 patien ts a residual perfusion originating from a lumbar artery was observed. In 7 /14 patients with AAA diameter >6 cm and without residual leakage on the co ntrol CT scan, aneurysm pulsation remained after endovascular treatment. Th ere was no early or late death after endovascular repair. During the follow -up period of 4 +/- 3 months patients are doing well. One patient needed ba lloon dilatation of an iliac limb. Conclusions: Endovascular treatment of AAA is a minimally invasive techniqu e with short recovery time. This technique seems to be particularly advanta geous in elderly or severely ill patients. Long-term controls are mandatory to identify potential complications, particularly when residual perfusion or aneurysm pulsation persists.