Endoluminal repair of abdominal aortic aneurysms - A critical reappraisal after a three-and-a-half year experience

This article reports midterm results from endoluminal repair of abdominal aortic aneurysms (AAAs). Between November 1993 and July 1997, 81 patients were treated using endovascular stent grafts. The configuration of the stent grafts was aorto-aortic in 2 patients, bifurcated in 21 patients and aorto-monoiliac in 57 patients. The mean diameters of the AAAs and of the common iliac arteries were 59 mm (range 39 to 95 mm) and 16.5 mm (9 to 53.5 mm), respectively. Contrast-enhanced spiral CT and DSA were used for preoperative imaging evaluation and for follow-up 1 month after stent-graft placement. Contrast-enhanced spiral CT was repeated at 3, 6, and 12 months postoperatively and thereafter biannually. There were 7 immediate conversions. Technical success was achieved in 74 patients (91%). Seven complications occurred during stent-graft deployment. Percutaneous reinterventions were performed on 35 occasions in 28 patients. The most frequent was stent placement due to kinks caused by distal stent-graft migration. Twenty patients underwent repeated surgery on 24 occasions, including seven late conversions due to: total migration (n = 6) and late proximal perigraft endoleak (n = 1); and seven required stent-graft extensions: six proximal ones due to migration and one distal one due to endoleak. Thus, complications occurred in 57 patients (77%). Thirty days mortality was 6% including four patients who were rejected for open surgical repair. We concluded that endoluminal repair of AAAs with complex arterial morphology is technically possible. Patients unfit for open surgery run a high risk for serious complication if their arterial anatomy is not favorable. Distal migration of stent-grafts raises the question of long-term durability.