Journal «Angiology and Vascular Surgery» • 

1998 • VOLUME 4 • №1

ENDOVASCULAR REPAIR OF AORTIC ANEURYSMS: RESULTS AND COMPLICATIONS

P. Heilberger, W. Ritter, Ch. Schunn, P. Gabriel, V. Bujanovsky, D. Raithel
Department of Vascular Surgery, Department of Radiology, City Hospital,
Nuernberg, Germany

Between August 1994 and December 1996 we performed erdovascular repairs of aortic aneurysms of varying sites in 137 patients. There were 10 women and 127 men aged 27 to 85 years (mean age 66 years). Five patients were diagnosed to have aneurysms of the descending portion of the thoracic aorta, 131 patients had aneurysms of the infrarenal part of the abdominal aorta, and one patient had an aneurysm of the common iliac artery. In 88 cases we employed straight (75 Min Tec, 12 EVT, I Chuter) graft-stents while bifurcation graft-slenis were useful in 43 cases (21 Min Tec, 20 EVT, 2 Chuter). The straight grafts Min Tec were employed in all five patients with thoracie aneurysms. A conic Min Tec stent was used in one patient with an aneurysm of the common iliac artery.

Intraoperative complications were recorded in eleven cases:

  1. Five grafts had defects of the coating, which did not ensure hermetic "exclusion "of an aneurysm.
  2. In two cases, the graft-stent was initially implanted into the area of the renal arteries which required its urgent removal.
  3. Latrogenic dissection of the aortic wall was recorded in one case.
  4. In one case, the graft, because of its excessive length, overlapped the opening of one of the iliac arteries.
  5. Primary leakage was recognised in the proximal «anastomosis» in one case.
  6. A large retroperitoneal hematoma along with the development ofhemorrhagic shock were identified in one case.

Thus, the total incjdence of intraoperative complications accounted for 8% (11 cases of the 137). One patient (0.7%) died. In the postoperative period, all the patients underwent standard control examinations which consisted of repeated computed tomography (CT) with the mandatory use of a contrast medium after 3 to 6 months and duplex scanning of the aorta with intravenous injection of Levo vist, a special cortrast substance manufactured by Sobering. The use ofLevovist makes it possible to intensify the Doppler signal and to raise the method sensitivity in identification ofgraft-stent leakage. The examination was supplemented by intraarterial digital subtraction angiography (DSA), provided the patients had thrombotic complications. The examinations carried out over the period from 2 to 24 months (mean 0.2 months) after operations have demonstrated that the initial leakage of straight grafts occurred in 15 (16%) cases. The secondary leakage seen at the late times in patients with an initially hermetic graft was revealed in eight more (8.5%) patients. Two patients developed thrombosis of the iliac artery following implantation of a straight aortic stent. After implantation of bifurcation grafts the initial leakage was established in 11 (25.6%) patients. Nine more (20.9%) patients were diagnosed to have thrombosis of one of the branches of the bifurcation graft (in 6 after Min Tec and in 3 after EVT stenting). Thrombotic complications were corrected by extraanatomicfemorofemoral bypass grafting (7 cases) and by catheter recanaliwtion and implantation of a Wall-stent (3 cases). We confined to conservative therapy in one patient who had no signs of limb ischemia.

P. 83-94

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