[Complications of endovascular treatment of aneurysm of the infrarenal abdominal aorta: incidence and treatment].

INTRODUCTION

Abdominal aortic aneurysms are the 13th leading cause of death in the United States. Conventional surgical treatment is associated with a low mortality of 1.4-5% and a higher morbidity in high-risk patients. Endovascular aneurysm repair is now performed in patients considered at too high risk for conventional repair. Although the use of endovascular grafts was initially limited, this method is gaining popularity despite the risk of complications including endoleaks, dislocation and graft thrombosis.

METHODS

Between June 1997 and June 2000, 28 patients were treated with endovascular stent grafts. 53 patients were treated by open surgical repair. Six patients presenting with rupture were excluded. Endoleaks were detected by arteriogram and computed tomographic scan. The mean aneurysm diameter, with a mean length of 3.2 cm, was 6.3 cm. The mean proximal neck diameter was not greater than 2.4 cm.

RESULTS

There were no conversions to open repair. The mean time of the intervention was 103 minutes. Nine patients with type I endoleaks underwent successful endovascular treatment; 2 patients presented a late type I endoleak treated in one case by dilatation. Four patients presented a type II endoleak after 6, 18, 30 and 32 months respectively, treated in two cases by embolization. Finally, erosion of the material was seen in four cases and a migration in one case. A decreased size of the aneurysms was seen in 10 cases, a stabilization in 12 cases, an augmentation of more than 5 mm in one case and a diminution followed by an augmentation in one case.

CONCLUSION

Key to success is restrictive patient selection due to morphological criteria and improvements in surgical techniques and equipment to reduce the incidence of specific treatment complications require a long-term follow-up.