Outcomes of endoprosthetic repair of abdominal aortic aneurysm

Popova I.V.¹, Ignatenko P.V.¹, Rabtsun A.A.¹, Saaya Sh.B.¹, Bugurov S.V.¹, Soborov M.A.², Popov V.V.³, Dyusupov A.A.⁴, Karpenko A.A.¹

¹Cardiosurgical Department of Vascular Pathology and Hybrid Technologies, Centre of Vascular and Hybrid Surgery, Meshalkin National Medical Research Centre of the RF Ministry of Public Health, Novosibirsk,
² Department of Hospital Surgery, Sechenov First Moscow State Medical University of the RF Ministry of Public Health, Moscow,
³ Department of Surgical Diseases, Novosibirsk National Research State University, Novosibirsk, Russia
⁴ Department of Cardiovascular and Thoracic Surgery, Semey Medical University, Semey, Kazakhstan

Objective. The study was aimed at assessing efficacy and safety of endovascular treatment of abdominal aortic aneurysms based on 11-year experience with implantation of stent grafts.

Patients and methods. We retrospectively analysed outcomes of treatment of 242 patients with abdominal aortic aneurysm during the period from 2008 to 2019. Of these, 210 (86.78%) were males, mean age 69.32±7.36 years. Diagnosis was made using colour duplex scanning and contrast-enhanced multislice spiral computed tomography, with implanting the following stent grafts: Ella – 44, Ovation Prime – 33, Anaconda – 13, Endurand – 77, Aortix – 2, Zenith – 33, Seal – 39, with one endoprosthesis placement failed. Assessing safety of the operation, we took into consideration lethality due to aortic rupture/thrombosis. Efficacy was taken to mean technical success of the operation (implantation of all components of the endograft without switch to open surgery), the number of reoperations.

Results. Technical success of the operation was achieved in 98.35% of cases. In 1 case due to pronounced arterial calcification for technical reasons we failed to position the stent graft and in another case – the contralateral leg of the Ella prosthesis. The early postoperative period revealed: type A1 endoleak – 3.7%, type IB – 4.13%, type IIA – 6.6%, type IIB – 4.54%, type III – 0.83%, type IV – 0.83%. Repeat operations were performed in 20 (8.2%) patients within 30 days after the intervention and in 32 (13.22%) in the remote period. In the early postoperative period two conversions were performed: 1) iliorenal bypass grafting for restoration of blood flow through the renal artery occluded by endoprosthesis wall; 2) evacuation of retroperitoneal haematoma due to rupture of the common femoral artery. Lethality during the whole period of follow up amounted to 32 (13.22%) cases. Of these, due to aortic complications 4.54% (n=11) and due to accompanying pathology 8.67% (n=21).

A direct correlation was revealed between the aortic diameter and duration of the operation which in turn increases the risk of complications requiring re-operation or resulting in a lethal outcome (RR – 1; 95% CD 1 – 1; p=0.026).

Conclusions. Our experience showed high safety and efficacy of stent graft implantation in treatment of patients with abdominal aortic aneurysms and high surgical risk.

KEY WORDS: aorta, aneurysm, endovascular treatment, endoprosthetic repair, stent graft.

Р. 69

« Back