Clinical and radiological outcome after endovascular abdominal aortic aneurysm repair: comparison of different grafts. preliminary single-center experience.

摘要

Endovascular repair (EVAR) represents a useful and validated alternative to conventional surgery in selected patients with abdominal aortic aneurysm (AAA) because it is associated with a significantly lower long-term AAA-related mortality. Data regarding a series of 91 patients (88 men, 3 women, median age 71 years, range 65-82 years) is reported. The patients were divided into three groups, according to the type of implanted stent (Endurant, Excluder and Talent). High American Society of Anesthesiologists Physical Status Classification System (ASA) was important in increasing the likelihood of an early complication (p=0.0007), while it did not have any effect on later adverse events, which were more closely related to the size of the aneurysm (p=0.006). As expected, the aneurysm diameter influenced the endoleak incidence (p=0.011), aneurysmal sac expansion (p=0.029), re-intervention risk (p=0.031) and the success of treatment (p=0.006). A significantly lower tendency for the development of endoleak (p=0.035) and other late complications (p=0.048) was observed in patients with Endurant device. This group seems to be more likely destined to achieve therapeutic success, but the difference was not significant. A borderline significance (p=0.071) with regard to early complications was also recorded. However, the use of this type of device did not affect survival, which was exclusively related to ASA (p=0.040). No other statistically significant differences were found between groups. Since open surgery for elective suprarenal AAA repair is still associated with considerable mortality, EVAR may offer several advantages over open repair surgery, including a less invasive operative procedure, and shortened intensive care unit and hospital stay. The technological improvements of the prosthesis for EVAR will likely reduce complications related to this technique in the near future.