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Endovascular treatment of abdominal aortic aneurysms: 6 years of experience at a single centre

Trattamento endovascolare di aneurismi dell’aorta addominale: esperienza monocentrica di sei anni

  • Vascular and Interventional Radiology / Radiologia Vascolare e Interventistica
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

We sought to assess the effectiveness of endovascular abdominal aortic aneurysm (AAA) repair (EVAR) through a retrospective review of 6 years’ experience at a single centre.

Materials and methods

From April 2005 to August 2011, 222 patients affected by abdominal aortic aneurysms underwent EVAR. We evaluated primary technical success, postprocedural mortality, intraprocedural and postprocedural complications with contrast-enhanced computed tomography (CT) and contrast-enhanced ultrasound (US) follow-up at 1, 6 and 12 months and annually thereafter.

Results

The procedures were elective in 75.7% and urgent due to symptomatic or ruptured aneurysm in 24.3%. Technical success was 98.6%; three patients (1.4%) required conversion to open surgery. Postoperative mortality rate was 24% for urgent and 2.3% for elective procedures. During a mean follow-up period of 29.6 months, no cases of stent-graft migration were observed; the overall incidence of endoleaks was 27% (60/222) and comprised four type I (1.8%) and one type III (0.45%), all treated by stent-graft extension, and 55 type 2 (24.8%), eight of which (14.5%) were treated by percutaneous injection of thrombin. In 10/222 cases (4.5%), thrombotic occlusion of the iliac extension was detected, which was successfully treated by transcatheter intra-arterial thrombolysis. One patient developed stent-graft infection requiring surgical explantation. Average hospital stay was 4 days, and average time in intensive care was 2 days.

Conclusions

Consistent with the literature data, our study confirms the safety and long-term efficacy of EVAR for treating AAA.

Riassunto

Obiettivo

Valutare l’efficacia del trattamento endovascolare degli aneurismi dell’aorta addominale (EVAR) mediante una valutazione retrospettiva monocentrica della nostra esperienza di 6 anni.

Materiali e metodi

Da aprile 2005 ad agosto 2011, 222 pazienti affetti da aneurisma dell’aorta addominale sono stati sottoposti a EVAR. Sono stati valutati il successo tecnico primario, la mortalità postoperatoria e a distanza, le complicanze intraprocedurali e postprocedurali mediante follow-up con angio-TC ed ecografia con mdc a 1, 6 e 12 mesi e poi annualmente.

Risultati

Gli interventi sono stati eseguiti in elezione nel 75,7% dei casi e in urgenza nel 24,3% per aneurisma sintomatico o rotto. Il successo tecnico si è ottenuto in 219 pazienti (98,6%); in 3 pazienti (1,4%) è stata necessaria la conversione chirurgica. La mortalità postoperatoria in elezione è stata del 2,3% (4/168) mentre in regime d’urgenza del 24% (13/54). A un follow-up medio di 29,6 mesi, l’incidenza complessiva di endoleak è stata del 27% (60/222): quattro endoleak di tipo I (1,8%) e uno di tipo III (0,45%), trattati mediante stent-graft, e 55 endoleak di tipo II (24,8%), di cui 8 trattati mediante iniezione translombare di trombina. In 10/222 casi (4,5%) si è riscontrata occlusione trombotica dell’estensione iliaca, trattata mediante trombolisi intrarteriosa. Si è riscontato un caso di infezione della protesi che ne ha richiesto l’espianto. La degenza ospedaliera media è stata di 4 giorni e il tempo medio in terapia intensiva di 2 giorni.

Conclusioni

Il nostro studio, in linea con i dati di letteratura, documenta la sicurezza e l’efficacia a lungo termine dell’EVAR.

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Authors and Affiliations

  1. S.C.D.U Radiodiagnostica e Radiologia Interventistica A.O.U. Maggiore della Carità, C.so Mazzini 18, 28100, Novara, Italy

    R. Fossaceca, G. Guzzardi, P. Cerini, M. Di Terlizzi, E. Malatesta, L. Filice & A. Carriero

  2. S.C.D. Chirurgia Vascolare A.O.U. Maggiore della Carità, Novara, Italy

    P. Brustia

Authors
  1. R. Fossaceca
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  2. G. Guzzardi
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  3. P. Cerini
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  4. M. Di Terlizzi
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  5. E. Malatesta
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Correspondence to R. Fossaceca.

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Fossaceca, R., Guzzardi, G., Cerini, P. et al. Endovascular treatment of abdominal aortic aneurysms: 6 years of experience at a single centre. Radiol med 118, 616–632 (2013). https://doi.org/10.1007/s11547-012-0905-8

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  • DOI: https://doi.org/10.1007/s11547-012-0905-8

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