engleski

Selection criteria for endovascular aortic reconstruction in patients with abdominal aortic aneurysms

Aim: Endovascular aortic reconstruction (EVAR) has lower short-term mortality and morbidity than open surgery for abdominal aortic aneurysms (AAA), but long-term results of EVAR are counterfeited by increased rate of complications. Patient selection is one of the factors affecting outcome after EVAR. However, EVAR is usually advised in patients with more severe cardiorespiratory comorbidities that would not withstand open surgical procedure, and are generally more prone to poor outcome. This may lead to selection of patients with less than ideal vessel anatomy, and compromising with quality of infrarenal aortic neck, distal landing zones, femoral access points or disregarding significant tortuosities or kinkings. The aim of this study was to evaluate selection criteria for endovascular aortic reconstruction (EVAR) and their potential influence on morbidity and mortality. Methods: Retrospective analysis of medical records of patients with abdominal aortic aneurysms who underwent EVAR from June 2015 until October 2016 at the Division of Vascular Surgery, University Hospital Centre Zagreb. In-hospital morbidity and mortality, as well as complications noted on follow ups, will be analyzed. Results: Fifteen patients were treated by EVAR for AAA at the Division of Vascular Surgery from June 2015 until October 2016. There was no in- hospital mortality. A lesion of a tortuotic left common iliac artery occurred in one male patient, which required open surgical intervention for hemostasis. While the patient recovered from hemorrhage, he developed pneumonia and was transferred to hospital for pulmonary diseases, but ultimately succumbed to respiratory insufficiency. Conclusion: The advantages of EVAR over open aortic reconstruction are evident in patients with multiple comorbidities or low expected life expectancy. However, a patient's characteristics should not be the governing criteria over vessel anatomy. Common and specific manufacturer's criteria for usage of the endografts should be respected as well, in order to optimize the results. An experienced and well integrated team of vascular surgeons and interventional radiologists should weigh both anatomic and clinical selection and exclusion criteria in order to improve both short and long- term results in this delicate group of patients.

endovascular aortic reconstruction ; abdominal aortic aneurysm

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