Endovascular Abdominal Aortic Aneurysm Repair in High Risk Patients: Outcomes of Management
Pramook Mutirangura MD*, Chutakiat Kruatrachue MD**, Pricha Ophasanond MD***, Walailak Chaiyasoot MD**, Chanean Ruangsetakit MD*, Chumpol Wongwanit MD*, Thanongchai Siriapisith MD**, Nuttawut Sermsathanasawadi MD*, Khamin Chinsakchai MD*, Orawan Phongraweewan MD***
Affiliation : * Vascular Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok **Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok *** Department of Anaesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Background : The concomitant cardiopulmonary disease precluded the elective repair for abdominal aortic
aneurysm (AAA) with acceptable risk. The endovascular abdominal aortic aneurysm repair (EVAR) has
become an alternative method for the treatment of AAA with high-risk comorbidities.
Objective : Evaluate the results of EVAR in high-risk patients with large AAA.
Materials and Methods : A prospective study of high-risk patients with large AAA and suitable morphology who
underwent EVAR between August 2003 and August 2005 was conducted. The long-term outcomes were observed
up to December 2006. The comorbidities, size of aneurysm, types of procedures, operative time, amount of
blood loss and transfusion, length of postoperative stay in intensive care unit and hospital, postoperative
complications and mortality were analyzed.
Results : Eight patients (7 males and 1 female) with the mean age of 71.4 years (range 66-83 years) were
included in the present study. The comorbidities were six of compromised cardiac status, one of severe pulmonary
disease and one of morbid obesity. The average size of aneurysm was 6.2 + 0.64 centimetres. One patient also
had large bilateral iliac artery aneurysms. Seven patients underwent EVAR with bifurcated aortic stent graft
and one proceeded with aorto uni-iliac stent graft. Three patients underwent preoperative coil embolisation
into internal iliac arteries when the distal landing zones at the external iliac arteries were considered. The
mean estimated blood loss was 369cc and the mean blood transfusion was 0.88 units. There were no
perioperative mortality, early graft occlusion, AAA rupture and open conversion in the present study. One
patient had cardiac arrest due to upper airway obstruction but with successful treatment. Type II endoleak
was observed in one patient and successfully treated by expectant management. One limb of bifurcated stent
graft was occluded at the 5th month post EVAR and was successfully treated by artery bypass surgery at both
groins. The 3-year primary graft limb patency was 87.5% (7/8). The survivals of patients at 1, 2 and 3 years
were 100%, 100% and 87.5% respectively. The cause of death in one patient was not related to EVAR.
Conclusion : EVAR may be a safe and effective alternative to open AAA repair especially in high-risk patients.
Keywords : Abdominal aortic aneurysm, Endovascular repair, High-risk patients, Outcomes of management.
