ENDOVASCULAR STENT GRAFT PLACEMENT FOR PATIENTS WITH AORTIC-ANEURYSM AND END-ORGAN DYSFUNCTION

Endovascular stent grafts (ESGs) for the treatment of aortic aneurysm is becoming popular because it is less invasiveness for the patient. T his new modality seems to be especially useful for treating high risk patients, such as those with endorgan dysfunction. In this study we re trospectively analyzed the results of ESG placement for patients with renal or hepatic dysfunction. From January 1996 to December 1997, six patients with end-organ dysfunction (two with descending thoracic aneu rysm and four with abdominal aneurysm) underwent ESG placement. Five o f these patients had renal dysfunction, with serum creatinine levels o f 2.0 mg/dl or greater, and the remaining patient had hepatic dysfunct ion with a prothrombin time less than 60%. One of the patients also ha d severe atherosclerotic disease with a history of multiple brain infa rctions. All the patients received custom made endovascular spiral Z s tents covered with a woven Dacron (DuPont Co., Wilmington, DE) graft, which was delivered via a femoral artery under local anesthesia. None of the patients showed significant changes in renal or hepatic functio n after the procedure. None of the five patients with renal dysfunctio n needed hemodialysis after ESG placement, although the mean preoperat ive level of serum creatinine and blood urea nitrogen was 3.4 mg/dl an d 42.0 mg/ dl, respectively. All the patients left the recovery room o n postoperative day 1. These results indicated that endovascular stent graft placement is extremely useful in the treatment of aortic aneury sm patients with end-organ dysfunction.