Experience of Endovascular Aneurysm Repair in Abdominal Aortic Aneurysm

Kim, Jang Yong; Do, Young Soo; Shin, Sung Wook; Kim, Young Wook; Kim, DongIk

Abstract

PURPOSE: We report our experience of endovascular aneurysm repair (EVAR) in Korea.
METHODS
The medical records of 11 EVARs between 1996 and 2004 in the Samsung Medical Center were reviewed retrospectively.
RESULTS
The abdominal aortic aneurysm (AAA)s were classified into 6 type A, 2 type B, 1 type C, 1 type D and 1 type E according to the anatomy. The indication of EVAR were the patient's choice (7) and the high surgical risk (4). The stent grafts used were Vanguard (4), AneuRX (3), Nitis-s (3), and the S&G (1). The mean time of the procedure, intensive care unit and post-procedral hospital stay were 3.9+/-0.8 hours, 25.1+/-13.6 hours and 7.9+/-2.8 days. There was no procedure related complications. After angiography had been performed, 1 type I endoleak and 5 type II endoleaks were found. The type I endoleak was treated with an extension of the stent-graft. The 4 type II endoleaks disappeared while the 1 type II endoleak was treated with glue embolization. During the follow up, 1 type I, 3 type II, and 3 type III endoleak were found. The type I endoleak was treated with glue embolization and the 3 type II endoleaks disappeared. The 2 type III endoleaks were treated with aortounilateral stent-graft insertion and a femorofemoral bypass, followed by a conversion to open repair. The 1 patient with the type III endoleak refused treatment. There was no 30-day mortality but 5 late mortalities. The causes of death were 2 myocardiac infarctions, 1 hepatoma, 1 pneumonia and 1 sepsis.
CONCLUSION
EVAR can be performed safely in high-risk patients but additional procedures may be needed during the follow-up. EVAR can be alternative option for the treatment of AAA in Korea if the experience of EVAR increases and the results improve.