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

• Kungurtsev V.V.
• Cherkashov A.M.
• Chernaya N.R.
• Kungurtsev E.V.
• Sorokin V.G.
• Khokhlov A.A.
• Konova S.V.

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

References

1. Pokrovsky A.V., Abugov S.A., Aleksanyan V.M., et al. Results of arthroplasty in patients with aneurysm of the infrarenal aorta. Angiology and Vascular Surgery. 2013; 19 (4): 108–113. (in Russian)

2. Bokeriya L.A., Pokrovsky A.V., Abugov S.A., et al. National guidelines for the management of patients with abdominal aortic aneurysm. Angiology and Vascular Surgery. 2013; 19 (2 Suppl.): 1–72. (in Russian)

3. Bokeriya L.A., Belov Yu.V., Khуbуlava G.G., et al. Clinical guidelines. Recommendations for the diagnosis and treatment of aortic diseases (2017). Kardiologiya i serdechno-sosudistaya khirurgiya. 2018; 11 (1): 5–68. (in Russian)

4. Chaikof E.L., Dalman R.L., Eskandari M.K., et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. Journal of Vascular Surgery. 2018; 67 (1): 2–77. DOI: https://doi.org/10.1016/j.jvs.2017.10.044

5. Wanhainen A., Verzini F., Van Htzeele I., et al. European Society for Vascular Surgery (ESVS) 2019 Clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. European Journal of Vascular and Endovascular Surgery. 2019; 57 (1): 8–93. DOI: https://doi.org/10.1016/j.ejvs. 2018.09.020

6. Steffen M., Schmitz-Rixen T., Jung G., et al. das Deutsche Institut für Gefäßmedizinische Gesundheitsforschung gGmbH (DIGG). Der DIGG-Risikoscore: Ein Vorhersagemodell der perioperativen Sterblichkeit bei elektiver Versorgung des intakten Bauchaortenaneurysmas im DIGG-Register. Chirurg. 2019; 90 (11): 913–920. DOI: https://doi.org/10.1007/s00104-019-0968-3

7. Greenhalgh R.M., Brown L.G., Kwong G.P., et al. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1) 30-day operative mortality results: randomized controlled trial. Lancet. 2004; 364 (9437): 843–848. DOI: https://doi.org/10.1016/S0140-6736(04)16979-1

8. Blankensteijn J.D., de Jong S.E., Prinssen M., et al. Dutch Randomized Endovascular Aneurysm Management (DREAM) Trial Group. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. New England Journal of Medicine. 2005; 352 (23): 2398–2405. DOI: https://doi.org/10.1056/NEJMoa051255

9. Zvereva E.D., Komakha B.B., Zverev D.A., et al. Results of a single-center study of open and endovascular prosthetics of abdominal aortic aneurysms. Angiology and Vascular Surgery. 2018; 24 (4): 126–130. (in Russian)

10. Krasheninin D.V., Yartsev S.E., Gavrilko A.D., Polyakov A.M. Stenting of a stent-graft branch in its acute occlusion after endovascular intervention for an abdominal aortic aneurysm. Angiology and Vascular Surgery. 2018; 24 (4): 159–168. (in Russian)

11. Gallitto E., Faggioli G., Mascoli C., et al. Long-term efficacy of EVAR in patients aged less than 65 years with an infrarenal abdominal aortic aneurysm and favorable anatomy. Annals of Vascular Surgery. 2020; 67: 283–292. DOI: https://doi.org/10.1016/j.avsg.2020.03.038

12. Polyakov R.S., Abugov S.A., Puretskiy M.V., et al. Endoprosthetics of the abdominal aorta in patients with infrarenal aneurysm and unfavorable anatomy of its proximal neck. Angiology and Vascular Surgery. 2015; 21 (4): 79–87. (in Russian)

13. Geraedts A.C.M., Mulay S., Vahl A., et al. Secondary interventions and long-term follow-up after endovascular abdominal aortic aneurysm repair. Annals of Vascular Surgery. 2021; 71: 381–391. DOI: https://doi.org/10.1016/j.avsg.2020.07.042

14. Charisis N., Bouris V., Conway A.M., Labropoulos N. A systematic review and pooled meta-analysis on the incidence and temporal occurrence of type II endoleak following an abdominal aortic aneurysm repair. Annals of Vascular Surgery. 2021; 75: 406–419. DOI: https://doi.org/10.1016/j.avsg.2021.01.083

15. Kychin I.V., Imaev T.E., Lepilin P.M., et al. Current state of the problem of endovascular treatment of abdominal aortic aneurysms of infrarenal localization. Angiology and Vascular Surgery. 2018; 24 (3): 60–66. (in Russian)

16. Chupin A.V., Deryabin S.V., Chigasov V.A. Embolization of the internal iliac artery during endoprosthetics of abdominal aortic aneurysms. Angiology and Vascular Surgery. 2019; 25 (4): 76–82. (in Russian)

17. Shahverdyan R., Gray D., Gawenda M., Brunkwall J. Single centre results of total endovascular repair of complex aortic aneurysms with custom made anaconda fenestrated stent grafts. European Journal of Vascular and Endovascular Surgery. 2016; 52 (4): 500–508. DOI: https://doi.org/10.1016/j.ejvs.2016.07.005

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