Endovascular repair for abdominal aortic aneurysms: the first hundred cases

Albert CW Ting, Stephen WK Cheng, P Ho, YC Chan, Jensen TC Poon, WK Yiu, Grace CY Cheung
Division of Vascular Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong

OBJECTIVE. To evaluate the early and mid-term results of the first 100 elective endovascular repairs for abdominal aortic aneurysms.

DESIGN. Retrospective analysis of prospectively collected data.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. The first 100 patients with infrarenal abdominal aortic aneurysms who underwent elective endovascular repair.

MAIN OUTCOME MEASURES. Peri-operative data, mortality and morbidities as well as the follow-up details were recorded. Cumulative data on endoleaks, clinical failures, secondary procedures, and survival were evaluated with Kaplan-Meier analyses.

RESULTS. There were 85 men and 15 women, with a mean age of 75 (range, 50-90) years. Failed implantations due to access difficulty occurred in two patients during the same period, giving a technical success rate of 98%. The mean aneurysm diameter was 6.2 cm. Access site injury requiring repair occurred in four (4%) of the patients, while wound problems were the most common complications (11%). The median hospital stay was 6 days, and there were two hospital deaths, giving a hospital mortality rate of 2%. During a mean follow-up of 36 (standard deviation, 24) months, there were three aneurysmal ruptures and four elective open conversions, with only one aneurysm-related death after hospital discharge. At 3 years, the cumulative rates of freedom from any endoleak, freedom from primary failure, freedom from secondary failure, freedom from secondary procedures, and survival were 60%, 84%, 89%, 88%, and 78%, respectively.

CONCLUSIONS. The early and mid-term results of elective endovascular repair for abdominal aortic aneurysms appear promising. The procedure is effective in preventing aneurysm-related death in the mid-term. Nevertheless, the importance of constant surveillance cannot be over-emphasised, as clinical failures and ruptures are still a concern.

Hong Kong Med J 2008;14:361-6

Key words: Aortic aneurysm, abdominal; Aortic rupture; Treatment outcome; Vascular surgical procedures