Endoprosthetic repair of infrarenal aneurysms of the abdominal aorta in elderly and aged patients

Abstract

Objective. The purpose of this study was to retrospectively analyze our experience in endoprosthetic repair of infrarenal aneurysms of the abdominal aorta with the assessment of both immediate and remote results of treatment.

Patients and methods. Analyzed herein are the results of endoprosthetic repair of infrarenal aneurysms of the abdominal aorta in a total of 32 elderly and aged patients with high operative risk. The patients’ age ranged from 60 to 80 years (median 68 years). Of these, 15 patients underwent endoprosthetic repair of the abdominal aorta using the Gore Excluder endoprosthesis and 17 patients received the Anaconda stent graft manufactured by the company Vascutek Ltd. The average diameter of abdominal aortic aneurysms amounted to 6.6 cm (from 50 mm to 75 mm). All patients met the anatomical criteria for roentgenoendovascular treatment.

Results. Technical success was achieved in 100% of cases, with no 30-day mortality. There were neither cardiac nor respiratory complications immediately after the operation. One patient was found to have an intraoperative complication in the form of a type IIIA endoleak related to insufficient sealing between the branch of the endoprosthesis and the main trunk, diagnosed at control angiography and eliminated by means of implanting an additional coated stent into the stent graft’s branch. Local postoperative complications in the area of the wound were observed in 4 (12.5%) patients. In the early postoperative period, 1 patient with implanted stent-graft Anaconda developed thrombosis of the graft’s branch. Blood flow was restored after thrombectomy from the graft followed by restenting. In the remote period, graft’s thrombosis was diagnosed in 2 patients. In 1 case we performed restenting of the graft’s branch and in the other case femorofemoral crossover bypass grafting. No migration of the stent graft was observed. The overall 5-year survival rate amounted to 70.0%.

Conclusion. Roentgenoendovascular prosthetic repair of infrarenal aneurysms of the abdominal aorta is a method of choice in elderly and aged patients with significant concomitant pathology.

Keywords:infrarenal aortic aneurysm; aortic endoprosthetic repair; stent graft; stent-graft branch thrombosis; thrombectomy; endoleaks

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CHIEF EDITOR
Akchurin Renat Suleymanovich
Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Sciences, Deputy General Director for Surgery, Head of the Department of Cardiovascular Surgery, National Medical Research Center for Cardiology named after Academician E.I. Chazov, President of the Russian Society of Angiologists and Vascular Surgeons

 

In accordance with the decision of the Presidium of the Russian Society of Angiologists and Vascular Surgeons, the journal "Angiology and Vascular Surgery" will be named after Academician A.V. Pokrovsky starting from No. 2/2022.

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