Endovascular aneurysm repair in high-risk patients

Purpose: The purpose of this study was to evaluate the role of endovascular aneurysm repair in high-risk patients. Methods: The elective endovascular repair of infrarenal aortic aneurysm was performed in 116 high-risk patients with either custom-made or commercial stent grafts. The routine follow-up examination included contrast-enhanced computed tomography (CT) before discharge, at 3, 6, and 12 months, and annu ally thereafter. Patients with endoleak on the initial CT underwent re-eval uation at 2 weeks. Those patients with positive CT results at 2 weeks under went endovascular treatment. Results: Endovascular repair was considered feasible in 67% of the patients . The mean age was 75 years, and the mean aneurysm diameter was 6.3 cm, The American Society of Anesthesiologists grade was II in 3.4%, III in 65.5%, IV in 30.1%, and V in 0.9%. There were no conversions to open repair. Custo m-made aortomonoiliac stent grafts were implanted in 77.6% of the cases, cu stom-made aortoaotic stent grafts in 11.2%, and commercial bifurcated stent grafts in 11.2%. The 30-day rates of mortality, major morbidity, and minor morbidity were 3.4%, 20.7%, and 12%, respectively, in the first 58 patient s and 0%, 3.4%, and 3.4%, respectively in the last 58. The late complicatio ns included five cases of stent graft kinking, two cases of femorofemoral g raft occlusion, and three cases of proximal stent migration, one of which l ed to aneurysm rupture. At 2 weeks after repair, endoleak was present in 10 .3% of the cases, All the type I (direct perigraft) endoleaks underwent suc cessful endovascular treatment, whereas only one type II (collateral) endol eak responded to treatment. The technical success rare at 2 weeks was 86.2% , and the clinical success rate was 96.6%. The continuing success rate was 87.9%. Seventeen patients died late, unrelated deaths. Conclusion: Endovascular aneurysm repair is safe and effective in patients at high risk, for whom it may be the preferred method of treatment.