2008, Number 4
<< Back Next >>
Rev Mex Angiol 2008; 36 (4)
Complicaciones en el tratamiento de aneurisma de aorta abdominal infrarrenal del adulto mayor
Marquina RME, Rodríguez TJM, Escotto SI, Rodríguez RN, Morales GLG, Espinosa APA
Language: Spanish
References: 26
Page: 126-134
PDF size: 101.07 Kb.
ABSTRACT
Objective: To report the local and systemic complications in patients underwent infrarrenal Abdominal
Aortic Aneurism (AAA) elective treatment.
Material and methods: Fifty-four files of patients with AAA diagnosis were reviewed from March
2006 to June 2008: 41 males (75.9%) and 13 (24.07%) females. With a mean age of 71.9 years (59 to
87 yr). Eighteen (33.3%) patients were treated, six by endovascular repair (EVAR) and 12 via open
repair (OR) in 2006; 25 (46.2%) patients, 18 in the EVAR group and seven in the OR group in 2007;
and 11 (20.37%) patients only treated by EVAR repair in 2008.
Results: There were 35 (64.81%) patients treated by EVAR and 19 (35.18%) via OR from which one
of them was treated by retroperitoneal approach. The comorbidities found were dislipidemia in 13
(37.1%) patients in the EVAR group and two (10.5%) in the OR group (p < 0.05); coronary artery disease
(CAD) in 17 (48.6%) patients in the EVAR group and one (5.3%) in the OR group (p < 0.05);
hypertension in 17 (48.6%) patients in the EVAR group and three (15.8%) in the OR group (p < 0.05);
Chronic Obstructive Pulmonary Disease (COPD) in 12 (34.3%) patients in the EVAR group and three
(15.8%) in the OR group (p = NS); Diabetes in three (8.6%) patients in the EVAR group, and no patients
found in the OR group (p = NS); Smoking in 15 (42.9%) patients in the EVAR group and six
(31.6%) patients in the OR group (p = NS); as additional factors there was a patient with larynx neoplasm,
one patient with only one kidney and two patients with kidney stones, one in each group
(EVAR and OR). No renal failure were reported. There was an ischemic stroke in the OR, two patients
with pulmonary failure, one in each group (EVAR and OR), five patients with acute renal failure,
none of them required long-term renal support, three (8.6%) in the EVAR group and two
(10.5%) in the OR group (p = NS). There were two deaths, one in each arm. There were no infection or
acute miocardial infarction (AMI) patients registered. In the local perioperative complications there
was one patient with one limb-graft occlusion in the EVAR arm and two acute limb ischemias in the
OR (p < 0.05), one retroperitoneal hematoma, one patient with evisceration, and one left renal vein
laceration; in the EVAR group there were three (15.8%) primary type I endoleak, and one primary
type 2 endoleak. There was one death in each group. The retroperitoneal patient presented no complications.
Discussion: The endovascular approach seems to offer some benefits in means of hospital total stay,
intensive care unit-days, blood loss and transfusion. In our experience there were as comorbidities
smoking and hypertension, although there is a significant difference of dislipidemia, coronary artery
disease and hypertension in patients underwent to EVAR. Even when the comparative data don’t
show a significant difference between them, there is a very characteristic clinical evolution on both
arms, which will be subject of further controlled studies.
Conclusion: The technical innovation and the anatomic evaluation of the aorta for the endovascular
procedures in pateints with abdominal aortic aneurysm has been subject of a raising number in this
sort of patients. The experience with the EVAR has shown advantages in the perioperative state and
it is just about to be completed as the long-term follow-up versus the OR in our institution. The open
repair continues being a good alternative with a low-complication rate in patients not eligible to endovascular
repair.
REFERENCES
Mendoza CA, Rodríguez TJM. Abordaje retroperitoneal en aneurismas de aorta abdominal. Rev Mex Angiol 2001; 29(1): 5-14.
Novelo de López HI, et al. Situación epidemiológica y demográfica del adulto mayor en la última década. RESPYN 2003; 5: 38-41.
Hobo R, Jacob B, EUROSTAR collaborators. Secondary interventions following endovascular abdominal aortic aneurysm repair using current endografts. A EUROSTAR report. J Vasc Surg 2006; 43(5): 896.
Coppi G, et al. Endovascular treatment of abdominal aortic aneurysms with the Powerlink Endograft System: influence of placement on the bifurcation and use of a proximal extension on early and late outcomes. J Vasc Surg en línea 2008. [Consultado el 30 junio].
Sivamurthy N, et al. Adjunctive primary stenting of Zenith endograft limbs during endovascular abdominal aortic aneurysm repair: implications for limb patency. J Vasc Surg 2006; 43(4): 662-70.
Greenberg RK, et al. Zenith abdominal aortic aneurysm endovascular graft. J Vasc Surg 2008; 48(1): 1-9.e2.
Peterson BG. Excluder bifurcated endoprosthesis investigators, five-year report of a multicenter controlled clinical trial of open versus endovascular treatment of abdominal aortic aneurysms. J Vasc Surg 2007; 45(5): 885-90.
Hiramoto SJ. Long-term outcome and reintervention after endovascular abdominal aortic aneurysm repair using the Zenith stent graft. J Vasc Surg 2007; 45(3): 461-6.
Greenhalgh RM, et al. Endovascular aneurysm repair versus open repair inpatients with abdominal aortic aneurysm (EVAR trial 1): randomized controlled trial. The Lancet 2005; 365: 2179-298.
Greenhalgh RM, et al. Endovascular aneurysm repair and outcome in inpatients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomized controlled trial. The Lancet 2005; 365: 2187-92.
Bush R, et al. Open versus endovascular abdominal aortic aneurysm repair in VA hospitals. J Am Coll Surg 2006; 202: 577-87.
Becquemin Jean-Pierre, et al. Colon ischemia following abdominal aortic aneurysm repair in the era of endovascular abdominal aortic repair. J Vasc Surg 2008; 47(2): 258-63.
Sharif MA, et al. Prosthetic stent graft infection after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2007; 6(3); 442-8.
Bade MA, et al. Endovascular abdominal aortic aneurysm repair in a patient with Ehlers-Danlos syndrome. J Vasc Surg 2007; 46(2): 360-2.
James AD, et al. Pancreatitis as a complication of endovascular aneurysm repair. Eur J Vasc Endovasc Surg 2008; 5(3): 310-11.
Jagadesham VP, Mavor MJ. Gough, unilateral gluteal compartment syndrome: a complication of open abdominal aortic aneurysm repair using an aortobifemoral bypass graft. Eur J Vasc Endovasc Surg 2008; 35(3): 378.
Jean-Baptiste E, et al. Percutaneous closure devices for endovascular repair of infrarenal abdominal aortic aneurysms: a prospective, non-randomized comparative study. Eur J Vasc Endovasc Surg 2008; 35(4): 422-8.
Manish M. Infrarenal abdominal aortic aneurysm repair via endovascular versus open retroperitoneal approach. Ann Vasc Surgery 2005; 19(3): 374-8.
Gioia LC. Hospital Readmissions Following Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2005; 19(1): 35-41.
Biancari F1, Leo, et al. Value of the glasgow aneurysm score in predicting the immediate and long-term outcome after elective open repair of infrarenal abdominal aortic aneurysm. Br J Surg 2003; 90(7): 838-44.
Maldonado TS, Rockman CB. Ischemic complications after endovascular abdominal aortic aneurysm repair. J Vasc Int Rad 2005; 16(2, Part 1): 304.
Lovegrove RE, et al. A meta-analysis of 21,178 patients undergoing open or endovascular repair of abdominal aortic aneurysm. British J Surg 2008; 95(6): 677-84.
Ghosh J. Late infection of an endovascular stent graft with septic embolization. Colonic perforation, and aortoduodenal fistula. Ann Vasc Surg 2006; 2: 263-6.
Zhou W. Repair of anastomotic abdominal aortic pseudoaneurysm utilizing sequential aneuRx aortic cuffs in an overlapping configuration. Ann Vasc Surg 2006; 20(1): 17- 22.
Jason RT, et al. Colonic ischemia complicating open vs. endovascular abdominal aortic aneurysm repair. J Vasc Surg 2008; 48(2): 272-7.
Bakoyiannis ChN. Fungal infection of aortoiliac endograft: a case report and review of the literature. Ann Vasc Surg 2007; (21)2: 228-31.
Full text