Abstract:

In this study we have analyzed early and long-term results of endovascular abdominal aneurysm repair (EVAR) in the Department of cardio-vascular surgery of «Russian Cardiology Research anc Production Complex».

Material and methods: research includes 164 patients (February 2009-November 2015) with abdominal aortic aneurysm (AAA), who underwent endovascular abdominal aneurysm repair (EVAR), also with difficult anatomy Patients were operated with basic methodics and also hybrid techniques («chimney», «octopus», fenestrated and branched devices).

Results: 30-day mortality rate accounted for 1,2%, all mortality was 3%.

References

1.      Nacional'nye rekomendacii po vedeniju pacientov s anevrizmami brjushnoj aorty 2011[National recommendations on treatment of patients with aneurysm of abdominal aorta]. Pod. red. A.V. Pokrovskogo [In Russ].

2.      Klinicheskaja angiologija: rukovodstvo dlja vrachej [Clinical angiology: guide-book fo physicians]. Pod red. A. V. Pokrovskogo. v 2-h tomah. T. 2. M.: Medicina, 2004 [In Russ].

3.      Abugov S.A., Belov Ju.V., Pureckij M. V., Saakjan Ju.M., Poljakov R.S., Hovrin V.V., Strucenko M.V. Sravnitel'nye rezul'taty lechenija anevrizm brjushnogo otdela aorty jendovaskuljarnym i hirurgicheskim metodom [Comparative results of treatment of abdominal aorta aneurysms with endovascular and surgical methods]. Kardiologija i serdechno-sosudistaja hirurgija. 2011; 2: 27-31 [In Russ].

4.      Sweet M.P., Fillinger M.F., Morrison.T.M., Abel D. The influence of gender and aortic aneurysm size on eligibility for endovascular abdominal aortic aneurysm repair. J. Vascular Surg. 2011; 54:931-7.

5.      Arko F.R., Filis K.A., Seidel S.A., Gonzalez J., Lengle S.J., Webb R., et al. How many patients with infrarenal aneurysms are candidates for endovascular repair? The Northern California experience. J. EndovascTher. 2004;11:33-40.

6.      Armon M.P., Yusuf S.W., Latief K., Whitaker S.C., Gregson R.H., Wenham P.W., et al. Anatomical suitability of abdominal aortic aneurysms for endovascular repair. Br. J. Surg. 1997;84:178-80.

7.      Carpenter J.P., Baum R.A., Barker C.F., Golden M.A., Mitchell M.E., Velazquez O.C., et al. Impact of exclusion criteria on patient selection for endovascular abdominal aortic aneurysm repair. J. Vasc. Surg. 2001;34:1050-4.

8.      Elkouri S., Martelli E., Gloviczki P., McKusick M.A., Panneton J.M., Andrews J.C., et al. Most patients with abdominal aortic aneurysm are not suitable for endovascular repair using currently approved bifurcated stent-grafts. Vasc. Endovascular. Surg. 2004;38:401-12.

9.      Moise M.A., Woo E.Y, Velazquez O.C., Fairman R.M., Golden M.A., Mitchell M.E., et al. Barriers to endovascular aortic aneurysm repair: past experience and implications for future device development. Vasc. Endovascular. Surg. 2006;40:197-203.

10.    Schumacher H., Eckstein H.H., Kallinowski F., Allen-berg J.R. Morphometry and classification in abdominal aortic aneurysms: patient selection for endovascular and open surgery. J. Endovasc. Surg. 1997;4:39-44.

11.    Mehta M., Byrne W.J., Robinson H., Roddy S.P., Paty P.S., Kreienberg P.B., et al. Women derive less benefit from elective endovascular aneurysm repair than men. J. Vasc. Surg. 2010;55:906-13.

12.    AbuRahma A.F., Campbell J., Stone P.A., et al. The correlation of aortic neck length to early and late outcomes in endovascular aneurysm repair patients. J. Vasc. Surg. 2009;50:738-748.

13.    Moulakakis K. G., Mylonas S. N., Avgerinos E. et al.The chimney graft technique for preserving visceral vessels during endovascular treatment of aortic pathologies J. Vasc. Surg. 2012; 55(5): 1497-1503.

14.    Aburahma A.F., Campbell J.E., Mousa A.Y, et al. Clinical outcomes for hostile versus favorable aortic neck anatomy in endovascular aortic aneurysm repair using modular devices. J. Vasc. Surg. 2011;54:13-21. 

Abstract:

Backgroud: endovascular implantation of the aortic stent-graft is a method of choice in treatment of aneurysms of the infrarenal abdominal aorta, especially in patients with high surgical risk.This strategy is characterized as less in-hospital complications, shorter in-hospital stay All these circumstances show some advantages of endovascular treatment compared with traditional «open» surgery. Besides that, there are some limitations for aortic endoprosthesis implantation, including short or conical proximal neck, severe angulation of aneurysmatic neck and tortuosity of arteries, insufficient diameter of iliac-femoral segment arteries for stent-graft delivery

Materials and methods: we report two clinical cases of successsful implantation of novel stent-graft OVATION PRIME in patients with adverse anatomy, precisely small diameter of crossing profile and original technology of proximal fixation of endoprosthesis.

Results: the use of innovative models of stent-grafts allows to proceed aortic endoprosthesis implantation with minimal risk of complications in certain patients with adverse vascular anatomy, who were previously deemed unsuitable for endovascular treatment.

References

1.     Jackson R.S., Chang D.C. Comparison of long-term survival after open vs endovascular repair of intact abdominal aortic aneurysm among Medicare beneficiaries. JAMA. 2012; 307: 1621-1628.

2.     Logevrove R.E., Javid M., Magee T.R., Galland R.B. A meta-analysis of 21,178 patient undergoing open or endovascular repair of abdominal aortic aneurysm. Br. J. Surg. 2008; 95:677-684.

3.     Brewster D.C., Cronenwett J.L., Hallett J.W. Jr, Johnston K.W., Krupski W.C., Matsumura J.S. Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J. Vasc.Surg. 2003;37:1106-17.

4.     Greenhalgh R.M., Brown L.C., Powell J.T., Thompson S.G., Epstein D., Sculpher M.J. Endovascular versus open repair of abdominal aortic aneurysm. N. Engl. J. Med. 2010;362:1863-71.

5.     Lederle F.A., Freischlag J.A., Kyriakides T.C., Padberg F.T. Jr, Matsumura J.S., Kohler T.R., et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA. 2009; 302:1535-42.

6.     Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project (HCUP). Available at: http://ahrg.gov/data/hcup/. Accessed September 26, 2012.

7.     Arko F.R. Filis K.A., Seidel S.A., Gonzalez J., Lengle S.J., Webb R., et al. How many patients with infrarenal aneurysms are candidates for endovascular repair? The Northern California experience. J. Endovasc Ther. 2004;11:33-40.

8.     Armon M.P., Yusuf S.W. Latief K., Whitaker S.C., Gregson R.H., Wenham P.W., et al. Anatomical suitability of abdominal aortic aneurysms for endovascular repair. Br. J. Surg. 1997;84:178-80.

9.     Carpenter J.P., Baum R.A, Barker C.F., Golden M.A. Mitchell M.E., Velazquez O.C., et al. Impact of exclusion criteria on patient selection for endovascular abdominal aortic aneurysm repair. J. Vasc.Surg. 2001;34: 1050-4.

10.   Elkouri S., Martelli E., Gloviczki P., McKusick M.A. Panneton J.M., Andrews J.C., et al. Most patients with abdominal aortic aneurysm are not suitable for endovascular repair using currently approved bifurcated stent-grafts. Vasc. Endovascular. Surg. 2004;38:401-12.

11.   Moise M.A., Woo E.Y, Velazquez O.C., Fairman R.M., Golden M.A., Mitchell M.E., et al. Barriers to endovascular aortic aneurysm repair: past experience and implications for future device development. Vasc. Endovascular. Surg. 2006;40:197-203.

12.   Schumacher H., Eckstein H.H., Kallinowski F., Allenberg J.R. Morphometry and classification in abdominal aortic aneurysms: patient selection for endovascular and open surgery. J. Endovasc.Surg. 1997;4:39-44.

13.   Mehta M., Byrne W.J., Robinson H., Roddy S.P, Paty PS., Kreienberg P.B., et al. Women derive less benefit from elective endovascular aneurysm repair than men. J. Vasc. Surg. 2010;55:906-13.

14.   Morrison T., Fillinger M., Meyer C., et al. Gender disparities in endovascular treatment options for infrarenal abdominal aortic аneurysms. http://www.fda.gov/downloads/MedicalDevices/NewsEvents/Workshops Conferences/UCM359044.pdf. Published June 25, 2013. Accessed June 20, 2014.

15.   AbuRahma A.F., Campbell J., Stone PA., et al. The correlation of aortic neck length to early and late outcomes in endovascular aneurysm repair patients. J. Vasc. Surg. 2009;50:738-748.

16.   Aburahma A.F., Campbell J.E., Mousa A.Y, et al. Clinical outcomes for hostile versus favorable aortic neck anatomy in endovascular aortic aneurysm repair using modular devices. J. Vasc.Surg. 2011;54:13-21.

17.   Sweet M.P, Fillinger M.F., MorrisonT.M., Abel D. The influence of gender and aortic aneurysm size on eligibility for endovascular abdominal aortic aneurysm repair. J. Vascular Surg. 2011; 54:931-7.