Celio T. Mendonca1, Claudio A. Carvalho2, Janaina Weingartner1, Alexandre Y. Shiomi2, Daniel S. Costa2, Cristiano M. Schmitt2
1Red Cross University Hospital. Positivo University, Curitiba, Brazil; 2VITA Curitiba Hospital, Curitiba, Brazil.
OBJECTIVES: To analyze the initial and long-term results of endovascular aneurysm repair (EVAR) in high-surgical-risk patients (i.e., age ≥80 years, serum creatinine level ≥3mg/dL, severe pulmonary dysfunction, severe cardiac dysfunction) with favorable anatomy (i.e., proximal neck length of at least 15mm, proximal neck angulation <60 degrees, absence of thrombus in the proximal neck).
METHODS: From April 2002 to November 2012, 80 consecutive high-surgical-risk patients (65 men; mean age 74 years, range 54-91 years) with an abdominal aortic aneurysm (AAA; mean diameter 66.6mm) who were treated electively using a bifurcated aortic endograft (39 Excluder, 40 Zenith, 1 Endurant) were entered in a prospective registry. Fifty-five (68.7%) patients were classified ASA III and 25 (31.3%) were ASA IV. High-surgical-risk status was corroborated using the validated customized probability index score. All patients used statins and beta blockers in the perioperative period. Primary endpoints were operative mortality and long-term survival; secondary endpoints were the frequency of reintervention, evolution of the aneurysm sac, rates of primary and secondary patency and rupture.
RESULTS: The mean customized probability index score in our patients was 12.1. Operative mortality was 1.25% (1/80). There were 5 endoleaks and 2 endograft limb occlusions. Four patients required reintervention during the mean follow-up of 35.9 months. Survival at 3 years was 91.25%. Primary and secondary patency rates at 3 years were 97.5% and 100%, respectively. There were no ruptures.
CONCLUSIONS: Our initial and long-term results with EVAR in high-risk patients were satisfactory and appear to justify this approach in this patient population. The most important factor for improvement of the short and long-term results of aortic endografts is respect of anatomic feasibility conditions.
AUTHOR DISCLOSURES: C. A. Carvalho: Nothing to disclose; D. S. Costa: Nothing to disclose; C. T. Mendonca: Nothing to disclose; C. M. Schmitt: Nothing to disclose; A. Y. Shiomi: Nothing to disclose; J. Weingartner: Nothing to disclose.
Posted April 2013