Armando Lobato, Luciana Camacho-Lobato
ICVE, Sao Paulo, Brazil.
OBJECTIVES: To analyze early and mid-term outcomes in patients undergoing the Sandwich Technique, hypogastric artery (HA) endo revascularization (ER), to treat complex aortoiliac aneurysms (AIA), isolated common iliac artery aneurysm (ICIAA) and abdominal aortic aneurysms (AAA) associated with bilateral short, non-diseased common iliac artery (CIA).
METHODS: Between October 2008 and November 2011, 52 patients undergoing elective endovascular aneurysm repair (EVAR) for AIA, ICIAA, or AAA with short, non-diseased CIA were treated using the Sandwich Technique. Patients were followed through office visits and CTA Demographic, clinical, and anatomical parameters and outcomes were recorded. Statistical analysis included descriptive and non-parametric statistical tests (Kruskal-Wallis and Dunn’s post Test) for aneurysm sac diameter assessment (Prism 5, Graph pad Software).
RESULTS: The mean age of the cohort was 73.8 years and 92.3% of patients were male. The mean follow-up was 15±7.4 months . There was no peri-operative mortality. Sixty HA ER (eight patients submitted a bilateral HA ER) were performed during this prospective study. HA ER technical success was 100%. Two-year primary HA ER patency was 93.3%. One late type III endoleak have appeared at 6 months and was not associated with aneurysm sac enlargement. At three-year, the overall mortality rate was 3.8%, all unrelated with aneurysm sac rupture. The assessment of the CIA aneurysm sac diameter by CTA revealed that 38.3% CIAA had a significant decrease (= least 5 mm), 60% remained stable and 1.7% had an increase of 6mm. Statistical significance (p<0.05) was reached only for comparisons between baseline (0 months) and 30 month measurements (p=0.027).
CONCLUSIONS: The Sandwich Technique, developed to overcome current anatomical and device constraints, has the promise of expanding the limits of endovascular aneurysm repair (EVAR) in a safe, easy to perform, and cost-effective manner. It is a useful tool in the armamentarium of the endovascular surgeon.
AUTHOR DISCLOSURES: L. Camacho-Lobato, Nothing to disclose; A. Lobato, Nothing to disclose.
Posted April 2012