Clinical outcomes after internal iliac artery embolization prior to endovascular aortic aneurysm repair
PURPOSE The aim of this study was to evaluate the feasibility of endovascular aortic aneurysm repair with use of an aortouniiliac graft secured with self-expanding (Gianturco) stents. METHODS Thirty patients with a median age of 72 years (age range, 52 to 86 years) and aneurysm diameter of 6.0 cm (range, 4.0 to 9.0 cm) were treated with an aortouniiliac endovascular graft. Of these 30 procedures, 28 were carried out electively and two as emergencies for leaking aneurysm. Of the 30 patients, 21 (70%) were considered to be at high risk for open surgery. A modified Gianturco stent, Dacron graft, and Wallstent were used for these procedures. RESULTS Endovascular repair was successfully carried out in 25 of 30 (83.3%) patients. All these patients were mobile and had resumed a normal diet within 48 hours of the procedure. The overall 30-day mortality rate was two in 30 (6.6%), but it was one in 28 (3.5%) for the elective cases; all deaths occurred in the group at high risk for surgery. Other complications encountered within 30 days of procedure included myocardial infarction in one patient, pneumonia in two patients, homonymous quadrantanopia in one patient, and colonic ischemia in one patient, giving an overall morbidity rate of four in 30 (13.3%). At a median follow-up of 4 months (range, 1 to 13 months), 27 of 30 (90%) patients remain alive and well. CONCLUSION Endovascular aortouniiliac repair of abdominal aortic aneurysm with Gianturco stent is feasible in both elective and emergency situations. It appears to be minimally traumatic, and the majority of patients deemed to be at high risk for open surgery can safely undergo endovascular repair. However, data on more patients with longer follow-up is required to determine its role in the management of abdominal aortic aneurysm.